title: Aortic arch repair: let it beat!
abstract: Objective aortic arch repair (AAR) on the beating heart may reduce cross-clamping times and offer improved postoperative cardiac function.Methods A single-center review of all patients (n = 24) who underwent surgical AAR during biventricular repair between 01/2006 and 01/2008 was done. All patients were operated on under cardiopulmonary bypass (CPB) with antegrade cerebral perfusion (ACP). During AAR, 13 patients (group 1) received cardioplegic arrest, and were compared to 11 patients (group 2) who underwent a beating-heart modification with selective myocardial perfusion. Seventeen patients had additional intracardiac lesions and underwent simultaneous correction during the procedure.Results Durations of CPB, AAR and ACP did not differ statistically between groups. Cardioplegic arrest time was significantly lower in group 1 (34 ± 13 vs. 76 ± 11 min, p = 0.02) and resulted in a subsequent reduction of myocardial ischemic damage as borne out by lower postoperative levels of troponin T and CK-MB (2.5 ± 0.7 vs. 7.1 ± 1.4 ng/mL, p = 0.02; 68.7 ± 11.5 vs. 149.1 ± 27.2 U/l, p = 0.03). We observed an enhanced patient recovery with shorter inotropic and ventilatory support times (p < 0.05).Conclusion Pediatric aortic arch correction on a CPB beating heart with selective myocardial perfusion is technically feasible and safe. The reduction of the myocardial ischemic time is effective and results in less myocardial damage.
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany. andre.rueffer@uk-erlangen.de
authors.forename: A
authors.initials: A
authors.lastname: Rüffer
authors.forename: C
authors.initials: C
authors.lastname: Klopsch
authors.forename: F
authors.initials: F
authors.lastname: Münch
authors.forename: U
authors.initials: U
authors.lastname: Gottschalk
authors.forename: T S
authors.initials: TS
authors.lastname: Mir
authors.forename: J
authors.initials: J
authors.lastname: Weil
authors.forename: H C
authors.initials: HC
authors.lastname: Reichenspurner
authors.forename: R A
authors.initials: RA
authors.lastname: Cesnjevar
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005858:Germany; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D010477:Perfusion / Q000379:methods; D020127:Recovery of Function; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D020107:Troponin T; D052279:Creatine Kinase, MB Form