Descending Aortic and Innominate Artery Cannulation for Aortic Arch Repair With Mildly Hypothermic Continuous Cardiopulmonary Bypass in Infants and Children

Abstract

A technique is described for exposure of the descending aorta, allowing separate arterial cannulation for perfusion of the upper and lower body during reconstruction of the aortic arch, maintaining continuous full-flow cardiopulmonary bypass to the entire body. This single technique is applicable to all aortic arch pathologies and allows an unhurried aortic reconstruction in an unobstructed field.

Valve-Sparing Root and Total Arch Replacement for Cutis Laxa Aortopathy

“…2,4,8 Herein we report the identification of a novel mutation in EFEMP2 and describe a total ascending aortic and arch repair in an affected three-year-old child using a dual aortic cannulation technique. 10…”

Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

“…A well-thought out preoperative plan can reduce the incidence of these injuries [2]. Particularly important to this surgery is the minimization of arterial and neurological complications [3]. A variety of cannulation sites are used to achieve this but are not always easily accessible or reliable.…”

Multi-center Data Frames Single-center Questions

“…Splanchnic and cerebral perfusion during arch reconstruction, avoidance of deep hypothermia (and its attendant coagulopathy, disruption of cellular homeostasis, and autoregulation), and judicious blood product control have shown decreased renal insult, decreased respiratory compromise, decreased perioperative instability, and have even made feasible the extubation of Norwood patients in the operating room. 13 Early separation from mechanical ventilation, minimal blood product transfusion, avoidance of deep hypothermia, continuous splanchnic, and cerebral perfusion during arch reconstruction show progress toward lower overall operative insult, shorter duration of mechanical ventilation, shorter ICU stay, and fewer complications, which are all shown to affect transplant-free survival. 13,14 The SVR data set continues to point to center differences that cloud the question of shunt type as a determinant of risk.…”

“…13 Early separation from mechanical ventilation, minimal blood product transfusion, avoidance of deep hypothermia, continuous splanchnic, and cerebral perfusion during arch reconstruction show progress toward lower overall operative insult, shorter duration of mechanical ventilation, shorter ICU stay, and fewer complications, which are all shown to affect transplant-free survival. 13,14 The SVR data set continues to point to center differences that cloud the question of shunt type as a determinant of risk. The same data set illuminates factors other than shunt type that contribute to outcome and prompt more questions about centerspecific operative, perioperative, and outpatient strategies that may have important influence.…”

“…13 Early separation from mechanical ventilation, minimal blood product transfusion, avoidance of deep hypothermia, continuous splanchnic, and cerebral perfusion during arch reconstruction show progress toward lower overall operative insult, shorter duration of mechanical ventilation, shorter ICU stay, and fewer complications, which are all shown to affect transplant-free survival. 13,14…”