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Gil-Jaurena JM, Pérez-Caballero R, Pita A, Pardo C, Monzón D, Pérez R, Ramírez B, Zamorano J. Cirugía de arco aórtico con circulación extracorpórea en período neonatal. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Baehner T, Breuer J, Heinze I, Duerr GD, Dewald O, Velten M. Low-body-perfusion via an arterial sheath reduces inflammation after aortic arch reconstruction surgery. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric cardiac surgeries involving aortic arch reconstruction are complex and require long cardiopulmonary bypass (CPB) times with deep hypothermic circulatory arrest (DHCA). Selective perfusion techniques have been developed to prevent the deleterious consequences of DHCA associated hypoperfusion. The effectivity of low body perfusion through cannulation of the femoral artery with an arterial sheath remains to be elucidated. We compared perfusion and inflammation in patients receiving selective antegrade cerebral perfusion (ACP) only to low body perfusion (LBP) in addition to ACP during DHCA for aortic arch reconstruction surgery. There was no difference in patient characteristics, cardiac pathologies, or performed procedures between ACP and LBP groups. Lactate levels increased after cardiac arrest in both groups. However, lactate levels were lower after 1 h reperfusion, at the end of extracorporeal circulation (ECC), and after surgery in LBP group compared to ACP only. Furthermore, creatinine was increased in ACP group on postoperative day 1 compared to LBP group but no acute kidney injury was observed in any group. IL-6 concentration increased in ACP group, while remained unchanged in LBP group compared to pre surgical values and were significantly lower compared to ACP group on postoperative days 1 and 2. LBP via an arterial sheath during cardiac arrest for aortic arch reconstruction surgery in addition to ACP, improves post ECC tissue perfusion as indicated by lower lactate levels and reduces creatinine levels suggesting milder kidney injury. LBP seems to prevent postoperative inflammation through a reduction in procedural duration or enhanced perfusion and thereby improves the outcome after aortic arch reconstruction surgery.
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Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology, St. Nikolaus Hospital, Andernach, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Oliver Dewald
- Department of Cardiac Surgery, University Medical Center Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Kreuzer M, Sames-Dolzer E, Schausberger L, Tulzer A, Ratschiller T, Haizinger B, Tulzer G, Mair R. Double-arterial cannulation: a strategy for whole body perfusion during aortic arch reconstruction. Interact Cardiovasc Thorac Surg 2019; 27:742-748. [PMID: 29722889 DOI: 10.1093/icvts/ivy147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Double-arterial cannulation enables cerebral perfusion and lower body perfusion during aortic arch reconstruction. The aim of this study was to analyse and report our experience of using this cannulation and perfusion technique on paediatric patients. METHODS A retrospective single-centre study was carried out on 407 consecutive paediatric patients who underwent an aortic arch reconstruction under double-arterial cannulation between 2003 and 2015. The median age of the patients at surgery was 8 (range 2-5570) days, and body weight was 3.3 (range 1.8-60) kg. All operations were performed through standard median sternotomy. One arterial cannula was inserted into the innominate artery and the second one into the supradiaphragmatic descending aorta. Primary end points were 30-day mortality, acute renal failure requiring dialysis and time until lactate level decreased to ≤2 mmol/l postoperatively. RESULTS We found an in-hospital mortality of 8.6%. Lethal incident was not associated with the cannulation method, and 1 intraoperative lesion of the descending aorta could be repaired immediately. The median lactate level of the patients on arrival at the intensive care unit was 3.5 mmol/l [quartile (Q)1: 2.3-Q3: 4.7] and creatinine was 0.48 mg/100 ml (Q1: 0.40-Q3: 0.58). The longest duration until the lactate level decreased to ≤ 2 mmol/l was found in the group of 264 univentricular patients (median 11 h, Q1: 6-Q3: 24). Seven (1.7%) patients of the whole cohort required peritoneal dialysis postoperatively. CONCLUSIONS Double-arterial cannulation is a simple and safe method for perfusing the brain and the lower parts of the body during aortic arch reconstruction. Perioperative survival and freedom from procedure-related complications in this demanding patient population are encouraging.
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Affiliation(s)
- Michaela Kreuzer
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Eva Sames-Dolzer
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Laura Schausberger
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Andreas Tulzer
- Division of Paediatric Cardiology, Children's Heart Centre Linz, Linz, Austria
| | - Thomas Ratschiller
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
| | - Bettina Haizinger
- Clinic of Anesthesiology and Intensive Care, Kepler University Hospital, Linz, Austria
| | - Gerald Tulzer
- Division of Paediatric Cardiology, Children's Heart Centre Linz, Linz, Austria
| | - Rudolf Mair
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
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Kellermann S, Janssen C, Münch F, Koch A, Schneider-Stock R, Cesnjevar RA, Rüffer A. Deep hypothermic circulatory arrest or tepid regional cerebral perfusion: impact on haemodynamics and myocardial integrity in a randomized experimental trial. Interact Cardiovasc Thorac Surg 2018; 26:667-672. [PMID: 29272381 DOI: 10.1093/icvts/ivx393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/18/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Organ protective management during aortic arch surgery comprises deep hypothermic (18°C) circulatory arrest (DHCA), or moderate hypothermia (28°C/ 'tepid') with regional cerebral perfusion (TRCP). The aim of this experimental study was to evaluate the effect of distinct organ protective management on hemodynamic performance and myocardial integrity. METHODS Ten male piglets were randomized to group DHCA (n = 5) or TRCP (n = 5) group and operated on cardiopulmonary bypass (CPB) with 60 min of aortic cross-clamping. Blood gas analysis was performed throughout the experiment. Haemodynamic assessment was performed using a thermodilution technique before and after CPB. Myocardial biopsies were taken 2 h after CPB and evaluated using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling assay and western blot analysis. RESULTS At reperfusion, levels of central venous saturation were significantly higher (P = 0.016) and levels of lactate significantly lower (P = 0.029) in the DHCA group. After CPB, thermodilution measurements revealed higher stroke volume and lower peripheral resistance in the TRCP group (P = 0.012 and 0.037). At the end of the experiment, no significant differences regarding laboratory and haemodynamic parameters were evident. All specimens showed enrichment of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling-positive cells exclusively at the left ventricular subendocardium with no difference between groups and equal concentrations of cyclo-oxygenase-2. CONCLUSIONS TRCP is associated with decreased peripheral resistance and higher stroke volume immediately after CPB. However, this beneficial effect is contrasted by signs of lower body hypoperfusion, which is expressed by lower central venous saturations and higher lactate levels. Distinct strategies of organ protection did not seem to affect apoptotic/necrotic and inflammatory changes in the left ventricular myocardium.
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Affiliation(s)
- Stephanie Kellermann
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carina Janssen
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Münch
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Adrian Koch
- Experimental Tumorpathology, Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Regine Schneider-Stock
- Experimental Tumorpathology, Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Anton Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - André Rüffer
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Sturmer D, Beaty C, Clingan S, Jenkins E, Peters W, Si MS. Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery. Transl Pediatr 2018; 7:139-150. [PMID: 29770295 PMCID: PMC5938255 DOI: 10.21037/tp.2018.03.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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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Affiliation(s)
- David Sturmer
- Department of Perfusion, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Claude Beaty
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Sean Clingan
- Deprtment of Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric Jenkins
- Department of Perfusion, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Whitney Peters
- Department of Perfusion, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Ming-Sing Si
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Tong Y, Liu J, Zou L, Feng Z, Zhou C, Lv R, Jin Y. Perioperative Outcomes of Using Different Temperature Management Strategies on Pediatric Patients Undergoing Aortic Arch Surgery: A Single-Center, 8-Year Study. Front Pediatr 2018; 6:356. [PMID: 30542643 PMCID: PMC6277883 DOI: 10.3389/fped.2018.00356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/01/2018] [Indexed: 01/12/2023] Open
Abstract
Background: With the widespread application of regional low-flow perfusion (RLFP), development of surgical techniques, and shortened circulatory arrest time, deep hypothermia is indispensable for organ protection. Clinicians have begun to increase the temperature to reduce hypothermia-related adverse outcomes. The aim of this study was to evaluate the safety and efficacy of elevated temperatures during aortic arch surgery with lower body circulatory arrest (LBCA) combined with RLFP. Methods: We retrospectively analyzed data from 207 consecutive pediatric patients who underwent aortic arch repair with LBCA & RLFP between January 2010 and July 2017 and evaluated different hypothermia management strategies. The overall cohort was divided into three groups: deep hypothermia (DH, 20.0-25.0°C), moderate hypothermia (MoH, 25.1-30.0°C) and mild hypothermia (MH, 30.1-34.0°C). Results: The percentage of AKI-1 occurrences was significantly increased in the MH group (51.52%) compared to those in the DH (25.40%) and MoH (37.84%) groups (P = 0.036); prolonged hospital stay occurrences were decreased with elevated temperature (DH 47.62%, MoH 28.83%, MH 18.18%, P = 0.006). Neurological complications, peritoneal dialysis, hepatic dysfunction, 30-day hospital mortality, delay extubation occurrences were no significant among the groups. Logistic analysis showed that the MH group was negatively associated with post-op AKI-1 compared with the DH group [OR = 0.329 (0.137-0.788), P = 0.013], no differences were found between the MoH and the MH group. Compared to other groups, the intubation time (P = 0.006) and postoperative hospital stay (P = 0.009) were significantly decreased in the MH group. Multivariate logistic analysis showed hypothermia levels were not significant with prolonged hospital stay. Conclusions: This retrospective analysis demonstrated that for pediatric patients undergoing surgeries with RLFP & LBCA, three different gradient temperature management strategies are available: deep, moderate, and mild hypothermia. Utilizing mild or moderate hypothermia is safe and feasible. Although the number of AKI-1 occurrences in the MH group was significantly increased compared to those in the other groups, further analysis showed no significance in the MoH and MH group, mild hypothermia management is as safe as others when used appropriately.
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Affiliation(s)
- Yuanyuan Tong
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Lihua Zou
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhengyi Feng
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Chun Zhou
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Ruoning Lv
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Yu Jin
- Department of Cardiopulmonary Bypass, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
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Raees MA, Morgan CD, Pinto VL, Westrick AC, Shannon CN, Christian KG, Mettler BA, Bichell DP. Neonatal Aortic Arch Reconstruction With Direct Splanchnic Perfusion Avoids Deep Hypothermia. Ann Thorac Surg 2017; 104:2054-2063. [PMID: 28709662 DOI: 10.1016/j.athoracsur.2017.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal aortic arch reconstruction, typically performed with deep hypothermia and selective cerebral perfusion, leaves splanchnic organ protection dependent on hypothermia alone. A simplified method of direct in-field descending aortic perfusion during neonatal arch reconstruction permits the avoidance of deep hypothermia. We hypothesize that direct splanchnic perfusion at mild hypothermia provides improved or equivalent safety compared with deep hypothermia and may contribute to postoperative extracardiac organ recovery. METHODS Included were 138 biventricular patients aged younger than 90 days undergoing aortic arch reconstruction with cardiopulmonary bypass. Patients were grouped according to perfusion method A (selective cerebral perfusion with deep hyperthermia at 18° to 20°C) or method B (selective cerebral perfusion and splanchnic perfusion at 30° to 32°C). Patient characteristics and perioperative clinical and serologic data were analyzed. Significance was assigned for p of less than 0.05. RESULTS Of the 138 survivors, 63 underwent method A and 75 underwent method B. The median age at operation was 8.5 days (range, 6 to 15 days), and median weight was 3.2 kg (range, 2.8 to 3.73 kg), with no significant differences between groups. Cardiopulmonary bypass times were comparable between the two perfusion methods (p = 0.255) as were the ascending aortic cross-clamp times (p = 0.737). The postoperative glomerular filtration rate was significantly different between our groups (p = 0.028 to 0.044), with method B achieving a higher glomerular filtration rate. No significant differences were seen in ventilator time, postoperative length of stay, fractional increase of postoperative serum creatinine over preoperative serum creatinine, and postoperative lactate. CONCLUSIONS A simplified method of direct splanchnic perfusion during neonatal aortic arch reconstruction avoids the use of deep hypothermia and provides renal protection at least as effective as deep hypothermia.
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Affiliation(s)
- Muhammad Aanish Raees
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Children's Hospital, Nashville, Tennessee
| | | | - Venessa L Pinto
- Critical Care Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Ashly C Westrick
- Department of Neurological Surgery, Vanderbilt School of Medicine, Children's Hospital, Nashville, Tennessee
| | - Chevis N Shannon
- Department of Neurological Surgery, Vanderbilt School of Medicine, Children's Hospital, Nashville, Tennessee
| | - Karla G Christian
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Children's Hospital, Nashville, Tennessee
| | - Bret A Mettler
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Children's Hospital, Nashville, Tennessee
| | - David P Bichell
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Children's Hospital, Nashville, Tennessee.
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Cesnjevar RA, Purbojo A, Muench F, Juengert J, Rueffer A. Goal-directed-perfusion in neonatal aortic arch surgery. Transl Pediatr 2016; 5:134-141. [PMID: 27709094 PMCID: PMC5035760 DOI: 10.21037/tp.2016.07.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve. Thus concepts of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP/with cardioplegic cardiac arrest or on the perfused beating heart) and TBP exist in parallel and all carry an individual risk for organ damage related to perfusion management, chosen core temperature and time on bypass. Patient safety relies more and more on adequate end organ perfusion on cardiopulmonary bypass, especially sensitive organs like the brain, heart, kidney, liver and the gut, whereby on adequate tissue protection, temperature management and oxygen delivery should be visualized and monitored.
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Affiliation(s)
- Robert Anton Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - Frank Muench
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - Joerg Juengert
- Department of Pediatrics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - André Rueffer
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany
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Kornilov IA, Sinelnikov YS, Soinov IA, Ponomarev DN, Kshanovskaya MS, Krivoshapkina AA, Gorbatykh AV, Omelchenko AY. Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion. Eur J Cardiothorac Surg 2015; 48:e45-50. [DOI: 10.1093/ejcts/ezv235] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/08/2015] [Indexed: 11/13/2022] Open
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Langley SM, Sunstrom RE, Reed RD, Rekito AJ, Gerrah R. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2013; 16:43-51. [PMID: 23561817 DOI: 10.1053/j.pcsu.2013.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Neonatal patients with hypoplasia of the aortic arch constitute a heterogeneous group with a wide spectrum of severity. The milder end of the spectrum comprises patients with aortic coarctation and isthmus hypoplasia. At the other end of the spectrum are patients with severe transverse arch hypoplasia or hypoplastic left heart syndrome. The aim of this paper is to discuss the various strategies and surgical approaches available for this group of patients, focusing on the surgical decisions that influence individual patient management. Many of the things discussed are applicable to any neonatal arch problem. We also describe and discuss in detail our surgical technique for patients who undergo neonatal repair of a hypoplastic aortic arch via median sternotomy.
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Affiliation(s)
- Stephen M Langley
- Section of Pediatric and Congenital Cardiac Surgery, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR 97239, USA.
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Karavas AN, Deschner BW, Scott JW, Mettler BA, Bichell DP. Three-Region Perfusion Strategy for Aortic Arch Reconstruction in the Norwood. Ann Thorac Surg 2011; 92:1138-40. [DOI: 10.1016/j.athoracsur.2011.03.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 02/22/2011] [Accepted: 03/21/2011] [Indexed: 11/27/2022]
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Ly M, Roubertie F, Belli E, Grollmuss O, Bui MT, Roussin R, Lebret E, Capderou A, Serraf A. Continuous Cerebral Perfusion for Aortic Arch Repair: Hypothermia Versus Normothermia. Ann Thorac Surg 2011; 92:942-8; discussion 948. [PMID: 21704296 DOI: 10.1016/j.athoracsur.2011.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 02/28/2011] [Accepted: 03/07/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamed Ly
- Department of Congenital Heart Surgery, Marie Lannelongue Hospital, University Paris-Sud, Le Plessis-Robinson, France.
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Aortenbogenoperation ohne hypothermen Kreislaufstillstand. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2008. [DOI: 10.1007/s00398-008-0666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Miyamoto T, Miyaji K, Okamoto H, Kohira S, Tomoyasu T, Inoue N, Ohara K. Higher cerebral oxygen saturation may provide higher urinary output during continuous regional cerebral perfusion. J Cardiothorac Surg 2008; 3:58. [PMID: 18973699 PMCID: PMC2583975 DOI: 10.1186/1749-8090-3-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 10/31/2008] [Indexed: 11/10/2022] Open
Abstract
Objective We examined the hypothesis that higher cerebral oxygen saturation (rSO2) during RCP is correlated with urinary output. Methods Between December 2002 and August 2006, 12 patients aged 3 to 61 days and weighing 2.6 to 3.4 kg underwent aortic arch repair with RCP. Urinary output and rSO2 were analyzed retrospectively. Data were assigned to either of 2 groups according to their corresponding rSO2: Group A (rSO2 ≦ 75%) and Group B (rSO2 < 75%). Results Seven and 5 patients were assigned to Group A and Group B, respectively. Group A was characterized by mean radial arterial pressure (37.9 ± 9.6 vs 45.8 ± 7.8 mmHg; P = 0.14) and femoral arterial pressure (6.7 ± 6.1 vs 20.8 ± 14.6 mmHg; P = 0.09) compared to Group B. However, higher urinary output during CPB (1.03 ± 1.18 vs 0.10 ± 0.15 ml·kg-1·h-1; P = 0.03). Furthermore our results indicate that a higher dose of Chlorpromazine was used in Group A (2.9 ± 1.4 vs 1.7 ± 1.0 mg/kg; P = 0.03). Conclusion Higher cerebral oxygenation may provide higher urinary output due to higher renal blood flow through collateral circulation.
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Affiliation(s)
- Takashi Miyamoto
- Department of Cardiothoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
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