Continuous systemic perfusion improves outcome in one stage repair of obstructed aortic arch and associated cardiac malformation.
OBJECTIVE
To determine whether continuous systemic perfusion is of effective use when establishing primary repair of the aortic obstruction and associated cardiac malformations.


METHODS
Since 1991, 56 infants have undergone reconstruction of interrupted (in 28) or coarctated (in 28) aorta, concomitantly with closure of ventricular septal defects in 37, and repair of other malformations in the remaining 19. Of these, total circulatory arrest (30+/-11 min) was employed in 23. In another 21 patients, perfusion was maintained for the carotid arteries with the descending aorta cross-clamped (31+/-15 min). The bodily organs were perfused throughout the operative procedures by placing dual aortic cannulae in the remaining 12 patients.


RESULTS
The postoperative courses were less eventful in the non-circulatory arrest group than other groups of patients undergoing total or partial circulatory arrest, although these groups were operated in different time periods, and consequently, a general progress might be one reason for improvements in the surgical outcomes. All patients undergoing no circulatory arrest survived the primary repair, could have the sternum primarily closed, and had no episodes of cerebral bleeding. Prolonged tracheal intubation was needed just in one patient of this group. The amount of urine output during cardiopulmonary bypass was significantly greater in the non-circulatory arrest group than in the others. The maximal concentrations of urinary beta-microglobulin, serous creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were lower in this setting.


CONCLUSIONS
Continuous systemic perfusion was considered less invasive when concomitantly repairing the obstructed aorta and intracardiac malformations.
Uemura
H
H
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Osaka, Japan. huemura@hsp.ncvc.go.jp
Yagihara
T
T
Kawahira
Y
Y
Yoshikawa
Y
Y
Kitamura
S
S
D000410:Alanine Transaminase / Q000097:blood; D001017:Aortic Coarctation / Q000150:complications / Q000601:surgery*; D001219:Aspartate Aminotransferases / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications; D001613:beta 2-Microglobulin / Q000652:urine
D001613:beta 2-Microglobulin; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase