One-stage total repair of aortic arch anomaly using regional perfusion.
OBJECTIVE
Primary repair of aortic arch obstructions and associated cardiac anomalies is a surgical challenge in neonates and infants. Deep hypothermic circulatory arrest prolongs myocardial ischemia and might induce cerebral and myocardial dysfunction.


METHODS
From March 2000 to December 2005, 69 neonates or infants with aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion in the presence of a nonworking beating heart using the dual perfusion technique on the innominate artery and aortic root. Preoperative diagnoses of arch anomaly comprised aortic coarctation (n=54) or an interrupted aortic arch (n=15). Combined anomalies were ventricular septal defect (n=52), anomalous origin of the right pulmonary artery from ascending aorta (n=3), hypoplastic left heart syndrome (n=2), truncus arteriosus (n=2), atrioventricular septal defect (n=2), double outlet right ventricle (n=1), total anomalous pulmonary venous return (n=1), partial anomalous pulmonary venous return (n=1), and aortic stenosis (n=1).


RESULTS
The mean regional perfusion time was 27.8+/-9.8 min. There was no operative mortality. Postoperative low cardiac output was present in four patients (5.8%). A neurologic complication was noted in one patient (1.5%) who developed transient chorea, but recovered completely. During 32.8+/-17.5 months of follow-up, one late death (1.5%) occurred. There was neither reoperation associated with arch anomaly nor recoarctation except in one patient. One patient developed left main bronchial compression necessitating aortopexy.


CONCLUSIONS
One-stage total arch repair using our regional perfusion technique is an excellent method that may minimize neurologic and myocardial complications without mortality. Our surgical strategy for arch anomaly has a low rate of residual and recurrent coarctation when performed in neonates and infants.
Lim
Hong-Gook
HG
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea.
Kim
Woong-Han
WH
Jang
Woo-Sung
WS
Lim
Cheong
C
Kwak
Jae Gun
JG
Lee
Cheul
C
Hwang
Seong Wook
SW
Lee
Chang-Ha
CH
D001015:Aortic Arch Syndromes / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery; D001927:Brain Diseases / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome