title: Norwood reconstruction using continuous coronary perfusion: a safe and translatable technique.
abstract: BACKGROUND
  Continuous coronary perfusion during Norwood reconstruction offers the theoretic advantage of less postoperative cardiac dysfunction. The avoidance of a cardiac and circulatory arrest period allows time for a more deliberate aortic reconstruction while the heart remains beating. This single-center study was designed to compare patient results using this method vs standard cardiac arrest for Norwood reconstruction.
  
  
  METHODS
  A retrospective review was done of 32 patients undergoing Norwood reconstruction from November 2004 to July 2011. The operations in the most recent 16 consecutive patients were performed under deep hypothermia with constant coronary and cerebral perfusion. Continuous coronary perfusion was provided by a cannula inserted into the proximal aorta. The operations in the prior 16 consecutive patients were performed using deep hypothermia, selective cerebral perfusion, and cardioplegic arrest during aortic reconstruction.
  
  
  RESULTS
  Survival in the beating-heart group was 87.5% (14 of 16) vs 62.5% (10 of 16) in the standard group (p = 0.22). No patients in the beating-heart group required extracorporeal membrane oxygenation vs 3 in the standard group. Postoperative cardiac function was similar for both groups. The beating-heart cohort had lower peak lactate levels (8.2 mEq/L) than the standard group (10.7 mEq/L, p = 0.022).
  
  
  CONCLUSIONS
  This study presents the largest series of Norwood operations in which the entire aorta is augmented while delivering continuous coronary perfusion. The technique is applicable to any size aorta and represents a safe alternative because outcomes for survival, freedom from extracorporeal membrane oxygenation, postoperative cardiac function, and lactate levels were all noninferior compared with the standard technique.
authors.affiliation: Division of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, Iowa 52242-1062, USA. joseph-turek@uiowa.edu
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Turek
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hanfland
authors.forename: Tina L
authors.initials: TL
authors.lastname: Davenport
authors.forename: Jose E
authors.initials: JE
authors.lastname: Torres
authors.forename: David A
authors.initials: DA
authors.lastname: Duffey
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Patel
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Reinking
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Poston
authors.forename: James E
authors.initials: JE
authors.lastname: Davis
mesh_terms: D003326:Coronary Circulation; D003331:Coronary Vessels; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007484:Iowa / Q000453:epidemiology; D008297:Male; D015425:Myocardial Reperfusion / Q000379:methods*; D058327:Norwood Procedures / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome