title: Direct innominate artery cannulation for antegrade cerebral perfusion in neonates undergoing arch reconstruction.
abstract: BACKGROUND
  Antegrade cerebral perfusion (ACP) is performed in neonates either by direct cannulation (DC) or indirect cannulation (IC) of the innominate artery. IC is achieved by a graft sutured to the innominate artery or advancement of a cannula through the ascending aorta into the innominate artery, whereas DC is performed by directly cannulating the innominate artery. These techniques may be limited by technical problems that can compromise perfusion. The purpose of the present study was to evaluate the flow measurements and safety of DC when compared with IC.
  
  
  METHODS
  This was a retrospective chart review of consecutive neonates who underwent ACP from January 2007 to December 2010. Patient characteristics, surgical and hemodynamic measurements, and postoperative neurologic findings were recorded.
  
  
  RESULTS
  Seventy neonates underwent ACP during the study period (46 using DC and 24 using IC). The groups were similar in age and weight. Operative variables were similar regarding cardiopulmonary bypass (CPB), cross-clamp times, maximal flow at full CPB, minimal temperature, ACP time, flow and flow index, and upper extremity blood pressure and proximal cannula pressure during ACP. There was a significantly higher flow index at full CPB in the DC group (217 ± 40 mL/kg/min versus 190 ± 46 mL/kg/min; p = 0.013), which correlated with higher proximal cannula pressures at full CPB (172 ± 27 mm Hg versus 158 ± 26 mm Hg; p = 0.04). Sixty-two of the 65 survivors (95%) had normal neurologic evaluations on discharge.
  
  
  CONCLUSIONS
  ACP using DC is comparable to that using IC, with appropriate pressures in the proximal aortic line at full CPB and adequate upper extremity pressures during ACP, reflecting suitable flows in the cerebral circulation.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. gabriela@clalit.org.il
authors.forename: Gabriel
authors.initials: G
authors.lastname: Amir
authors.forename: Georgy
authors.initials: G
authors.lastname: Frenkel
authors.forename: Golan
authors.initials: G
authors.lastname: Shukrun
authors.forename: Omar
authors.initials: O
authors.lastname: Gogia
authors.forename: Oren
authors.initials: O
authors.lastname: Bachar
authors.forename: Elchanan
authors.initials: E
authors.lastname: Bruckheimer
authors.forename: Jacob
authors.initials: J
authors.lastname: Katz
authors.forename: Einat
authors.initials: E
authors.lastname: Birk
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002404:Catheterization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007231:Infant, Newborn; D008297:Male; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*