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One Stage Total Repair of the Aortic Arch Anomaly using the Regional Perfusion  

Jang Woo-Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Lim Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
Lim Hong-Kook (Department of Thoracici and Cardiovascular Surgery, Sejong General Hospital)
Min Sun-Kyung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Kwak Jae-Kun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Chung Eui-Seuk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Kim Dong-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Kim Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University of Medicine)
Publication Information
Journal of Chest Surgery / v.39, no.6, 2006 , pp. 434-439 More about this Journal
Abstract
Background: Deep hypothermic circulatory arrest during repair of aortic arch anomalies may induce neurological complications or myocardial injury. So we surveyed if the regional cerebral and myocardial perfusion might eliminate those potential side effects. Material and Method: From March 2000 to December 2004, 62 neonates or infants with aortic arch anomaly underwent one stage biventricular repair using the regional perfusion technique by single surgeon. Preoperative diagnosis of the arch anomaly consisted of coarctation (n=46), interruption of the aorta (n=12), hypoplastic left heart syndrome (n=2) and truncus areteriosus (n=2). Combined anomalies were ventricular septal defect (n=51), TAPVR (n=1), PAPVR (n=1) and atrioventricular septal defect (n=2). Arterial cannula was inserted at the innominate artery. Result: The mean regional perfusion time of brain was $28{\pm}10min$. Operative mortality rates was 0 (0/62). Late death was 1 (1/62) during $11{\pm}7$ months of follow-up. Neurologic complications consisted of transient chorea in 1 case. There was no reoperation associated with arch anolamy. Pulmonary complication associated with arch repair occurred in f case which was managed by aortopexy. Conclusion: One-tage rch repair using the regional profusion is safe and effective in minimizing the neurologic and myocardial complications.
Keywords
Regional blood flow; Aorta, arch; Hypothermia; Neurocognitive deficits;
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1 Jonas RA, Wernovsky G, Ware J, et al. The Boston circulatory arrest study: perioperative neurologic and developmental outcome after the arterial switch operation. Circulation 1992;86(Suppl):1360
2 Pigula FA, Siewers RD, Nemoto EM. Regional perfusion of the brain during neonatal aatic arch reconstruction. J Thorac Cardiovasc Surg 1999;117:1023-4   DOI   ScienceOn
3 Ishino K, Kawada M, Irie H, Kino K, Sano S. Single-stage repair of aortic coarctation with ventricular septal defect using isolated cerebral and myocardial perfusion. Eur J Cardiothorac Surg 2000;17:538-42   DOI   ScienceOn
4 Pigula FA. Arch reconstruction without circulatory arrest: scientific basis for continued use and application to patients with arch anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002;5:104-15   DOI   ScienceOn
5 McElhinney DB, Reddy VM, Silverman NH, Hanley FL. Modified Damus-Kaye-Stansel procedure for single ventricle, subaortic stenosis, and arch obstruction in neonates and infants: midterm results and techniques for avoiding circulatory arrest. J Thorac Cardiovasc Surg 1997;114:718-25   DOI   ScienceOn
6 Oates RK, Simpson JM, Turnbull JAB, Cartmill TB. The relationship between intelligence and duration of circulatory arrest with deep hypothermia. J Thorac Cardiovasc Surg 1995;110:786-92   DOI   ScienceOn
7 Asou T, Kado H, Imoto Y, et al. Selective perfusion technique during aortic arch repair in neonates. Ann Thorac Surg 1996;61:1546-8   DOI
8 Glauser TA, Rorke LB, Weinberg PM, Clancy RR.Acquired neuropathologic lesions associated with the hypoplastic left heart syndrome. Pediatrics 1990;85 :991-1000
9 Sano S, Mee RBB. Isolated myocardial perfusion during arch repair. Ann Thorac Surg 1990;49:970-2   DOI   ScienceOn
10 Kern FH, Ungerleider RM, Reves JG, et al. The effect of altering pump flow rate on cerebral blood flow and metabolism in infants and children. Ann Thorac Surg 1993;56: 1366-72   DOI   ScienceOn
11 Hickey PR. Neurologic sequelae associated with deep hypothermic circulatory arrest. Ann Thorac Surg 1998;65:S65-70   DOI   ScienceOn
12 Pigula FA, Gandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM. Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery. Ann Thorac Surg 2001;72:401-6   DOI   ScienceOn
13 Asou T, Kado H, Imoto Y, et al. Selective cerebral perfusion technique during aortic arch repair in neonates. Ann Thorac Surg 1996;61:1546-8   DOI
14 Newburger JW, Jonas RA, Wemovsky G, et al. A comparison of the perioperative neurobgic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993;329:1057-64   DOI   ScienceOn
15 Bellinger DC, Jonas RA, Rappaport LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 1995;332:549-55   DOI   ScienceOn
16 Newberger JW, Jonas RA, Wemovsky G, et al. A comparison of the perioperative effects of hypothermic circulatoryarrest versus low flow cardiopulmonary bypass. N Engl J Med 1993;329:1057-64   DOI   ScienceOn
17 Greeley WJ, Kern FH, Ungerleider RM, et al. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg 1991;101:783-94
18 Hickey PR. Neurologic sequelae associated with deep hypothermia circulatory arrest. Ann Thorac Surg 1998;65:S65-70   DOI   ScienceOn