Coronary and Cerebral Perfusion During Arch Reconstruction in Neonates

Tsvetomir Loukanov, Murat Uzdenov, Matthias Gorenflo, Matthiás Karck

University of Heidelberg, Germany, Heidelberg, Germany

Date, time and location: 2018.05.26 08:30, Press Hall, 2F

Abstract

We assessed whether regional cerebral perfusion is neurologically safe during long-term follow up, and evaluated the effect of our current combined coronary perfusion strategy by comparing outcomes of nonworking beating hearts and arrested hearts under regional cerebral perfusion. (Lim et al. Ann Thorac Surg, 2010)

From January 2014 to October 2017, 32 neonates or infants with an aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion with non- ejecting beating heart using the dual-perfusion technique through the innominate artery and aortic root.

There were no hospital mortalities. A injury of nervus phrenicus occurred in 2 patients, who recovered completely.

The patients operated with this technique had no myocardial ischemic time and deep hypothermic circulatory arrest, which resulted in less total inotropic and vasopressin requirements, and also less delayed sternal closure, duration of ventilator care and chest tube drainage, amount of pleural effusion, and lengths of intensive care unit and hospital stay

One-stage total arch repair under regionalcerebral perfusion provides an excellent means of minimizingneurologic complications during long-term follow

up. Our perfusion strategy, based on originally described from Lim et al. for arch anomaly under continuous cerebral perfusion with a nonworking beating heart using the dual-perfusion technique may also minimize myocardial complications and morbidities, and should be recommended, particularly in neonates and patients with complex anomalies.