Direct Arterial Cannulation Allows Easy and Safe Continuous Selective Cerebral Perfusion During Repair of Interrupted Aortic Arch Even for Low Birth Weight Neonates

Qiang Chen, Massimo Caputo, Serban Stoica, William Lansdowne, Andrew J Parry

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

OBJECTIVES: To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight.

METHODS: Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated.

RESULTS: Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications.

CONCLUSIONS: Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.

Original languageEnglish
Pages (from-to)464-468
Number of pages5
JournalWorld Journal for Pediatric and Congenital Heart Surgery
Volume10
Issue number4
DOIs
Publication statusPublished - Jul 2019

Keywords

  • Angiography
  • Aorta, Thoracic/abnormalities
  • Catheterization/methods
  • Cerebrovascular Circulation/physiology
  • Female
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Male
  • Perfusion/methods
  • Treatment Outcome
  • Vascular Malformations/physiopathology
  • Vascular Surgical Procedures/methods

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