title: Continuous cerebral and myocardial perfusion during aortic arch repair in neonates and infants.
abstract: To minimize myocardial ischemia, we repaired aortic arch obstruction with ventricular septal defect, using two different techniques of cerebral and myocardial perfusion. Seventy-one infants, ages 3 to 137 days, underwent primary repair of coarctation of the aorta (n = 49)/interruption of the aortic arch (n = 22) with ventricular septal defect. In 65 patients, an end-to-end arch anastomosis was performed with cerebral and myocardial perfusion through the innominate or the ascending arterial cannula (non-working beating heart: NWBH). In the remaining 6 patients, an arterial cannula was placed into the innominate artery. With partial cardiopulmonary bypass, the innominate artery was snared proximal to the cannulation site and the ascending aorta was cross-clamped. An extended arch anastomosis was carried out with cerebral perfusion and a working beating heart (WBH). Ten patients (15%) undergoing aortic arch repair with the NWBH technique required cardioplegic arrest to complete a proximal anastomosis, whereas in all 6 repairs with the WBH technique, the extended anastomoses were completed without myocardial ischemia. One hospital death and late death occurred, with an overall survival of 98%. End-to-end arch reconstruction is feasible without myocardial ischemia, using the NWBH technique in patients without hypoplastic arch and using the WBH technique in patients with hypoplastic arch.
authors.affiliation: Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kotani
authors.forename: Kozo
authors.initials: K
authors.lastname: Ishino
authors.forename: Shingo
authors.initials: S
authors.lastname: Kasahara
authors.forename: Ko
authors.initials: K
authors.lastname: Yoshizumi
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawada
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
mesh_terms: D001011:Aorta / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control*; D010477:Perfusion / Q000379:methods*