Neonatal Aortic Arch Reconstruction With Direct Splanchnic Perfusion Avoids Deep Hypothermia

Raees, Muhammad; Morgan, Clinton D.; Pinto, Venessa; Westrick, Ashly C.; Shannon, Chevis N.; Christian, Karla G.; Mettler, Bret A.; Bichell, David P.

doi:10.1016/j.athoracsur.2017.04.037

Cited by 19 publications

(20 citation statements)

References 25 publications

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“…However, no significant differences were seen in postoperative length of stay, postoperative lactate levels or time on a ventilator. Moreover, the ratio of increase of post-operative serum creatinine vs. preoperative serum creatinine was also the same between treatment groups (95). While this data may suggest that splanchnic perfusion at mild hypothermia provides comparable protection, it in no way suggests superiority and further studies will need to be performed in order to better illustrate this principle.…”

Section: Perfusion Techniquesmentioning

confidence: 72%

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer¹,

Beaty²,

Clingan³

et al. 2018

Transl Pediatr

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Abstract:The development and refinement of cardiopulmonary bypass (CPB) has made the repair of complex congenital heart defects possible in neonates and infants. In the past, the primary goal for these procedures was patient survival. Now that substantial survival rates have been achieved for even the most complex of repairs in these patients, focus has been given to the reduction of morbidity. Although a necessity for these complex neonatal and infant heart defect repairs, CPB can also be an important source of perioperative complications. Recent innovations have been developed to mitigate these risks and is the topic of this review. Specifically, we will discuss improvements in minimizing blood transfusions, CPB circuit design, monitoring, perfusion techniques, temperature management, and myocardial protection, and then conclude with a brief discussion of how further systematic improvements can be made in these areas.

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Section: Perfusion Techniquesmentioning

confidence: 72%

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer¹,

Beaty²,

Clingan³

et al. 2018

Transl Pediatr

View full text Add to dashboard Cite

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“…Surgery for aortic arch reconstruction with aortic coarctation can be performed with various surgical approaches for cardiopulmonary bypass. Deep hypothermia and circulatory arrest ( 32 – 34 ) has been progressively replaced by regional cerebral perfusion ( 35 – 38 ) with or without associated myocardial perfusion and beating heart ( 39 , 40 ), and more recently with distal aortic cannulation for lower body perfusion ( 41 – 43 ). Our standard approach was to use regional cerebral and myocardial perfusion with aortic cross clamping and myocardial ischemia only for the repair of the associated intra-cardiac defects, but we do not consider this matter relevant for the surgical results related to this study.…”

Section: Discussionmentioning

confidence: 99%

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

et al. 2018

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Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects.Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications.Results: In a median follow-up time of 1.5 ± 1.1 years (0.6–2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1–17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s.Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix).

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“…To maintain normothermia, they are now experimenting with splanchnic perfusion to prevent renal and gut exposure to circulatory arrest. These authors have reported satisfactory results in terms of visceral and neurological function (15). Notably, Fraser and colleague recommended a higher ACP flow rate at 50-80mL/Kg/min (14).…”

Section: Target Temperature and Flow Ratementioning

confidence: 97%

Continuous Cerebral and Myocardial Selective Perfusion in Neonatal Aortic Arch Surgery

Maminirina

Pavy

Bourgoin

et al. 2020

Preprint

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BACKGROUND: To assess the feasibility and outcome of Continuous Cerebral and Myocardial Selective Perfusion (CCMSP) during aortic arch surgery in neonates. METHODS: This retrospective single-center study was conducted between 2008 and 2019 in neonates undergoing aortic arch surgery, accompanied or not by cardiac malformation repair. CCMSP at moderate hypothermic of 28°C was achieved using selective brachiocephalic artery and ascending aorta cannulation. Target rates of cerebral and myocardial perfusion were 25-35 mL/kg/min and 150/m2/min. Cardiopulmonary bypass (CPB) variables and clinical outcomes were analyzed. RESULTS: Overall, 69 neonates underwent either isolated aortic arch repair (n=31) or aortic arch repair with ventricular septal defect (VSD) closure (n=38). The mean age and weight were 9.79±7.1 days and 3.17±0.4Kg, respectively. Mean CPB and aortic clamping times were 133.5±47.0 and 25.2±5.3 min for isolated aortic arch repair, and 158.4±47.9 and 75.4±30.5 min for aortoplasty accompanied by VSD closure. Mean CCMSP time was 51.6±21.5 min with cerebral rate of 32.6±10.0mL/Kg/min. Two major complications arose: stroke (n=1; 1.44%) and transient renal failure requiring dialysis (n=2; 2.89%). Neither myocardial nor visceral ischemia occurred. In-hospital mortality was 1/69 (1.44%). CONCLUSIONS: CCMSP is a safe and reproducible strategy for cerebral, myocardial and visceral protection in neonatal aortic arch repair, with or without VSD closure, resulting in low complication and mortality.

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Neonatal Aortic Arch Reconstruction With Direct Splanchnic Perfusion Avoids Deep Hypothermia

Cited by 19 publications

References 25 publications

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

Continuous Cerebral and Myocardial Selective Perfusion in Neonatal Aortic Arch Surgery

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