title: Cannulation strategy for aortic arch reconstruction using deep hypothermic circulatory arrest.
abstract: BACKGROUND
  Aortic arch reconstruction in neonates is commonly performed using deep hypothermic circulatory arrest. However, concerns have arisen regarding potential adverse neurologic outcomes from this complex procedure, raising questions about the best arterial cannulation approach for cerebral perfusion and effective systemic hypothermia. In this study, we use computational fluid dynamics to investigate the effect of different cannulation strategies in neonates.
  
  
  METHODS
  We used a realistic template of a hypoplastic neonatal aorta as the base geometry to investigate four cannulation options: (1) right innominate artery, (2) innominate root, (3) patent ductus arteriosus (PDA), or (4) innominate root and PDA. Performance was evaluated according to the numerically predicted cerebral and systemic flow distributions compared with physiologic perfusion under neonatal conditions.
  
  
  RESULTS
  The four cannulation strategies were associated with different local hemodynamics; however, this did not translate into any significant effect on the measured flow distributions. The largest difference only represented 0.8% of the cardiac output and was measured in the innominate artery, which received 23.2% of the cardiac output in option 3 vs 24% in option 4. Pulmonary artery snaring benefited all systemic vessels uniformly.
  
  
  CONCLUSIONS
  Because of the very high vascular resistances in neonates, downstream vascular resistances dictated flow distribution to the different vascular beds rather than the cannulation strategy, allowing the surgical team to choose their method of preference. However, patients with aortic coarctation warrant further investigation and will most likely benefit from a 2-cannulae approach (option 4).
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332-0535, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: de Zélicourt
authors.forename: Philsub
authors.initials: P
authors.lastname: Jung
authors.forename: Marc
authors.initials: M
authors.lastname: Horner
authors.forename: Kerem
authors.initials: K
authors.lastname: Pekkan
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Yoganathan
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002404:Catheterization; D050792:Circulatory Arrest, Deep Hypothermia Induced; D006801:Humans; D008953:Models, Anatomic