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a Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Korea
b Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
c Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Bundang, Korea
Accepted for publication March 19, 2010.
* Address correspondence to Dr W-H Kim, Department of Thoracic and Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744, Korea (Email: woonghan{at}snu.ac.kr).
Background: 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.
Methods: From March 2000 to October 2008, 159 neonates or infants with an aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion. Patients (group A, n = 111) under continuous cerebral perfusion with a nonworking beating heart using the dual-perfusion technique through the innominate artery and aortic root were compared with patients (group B, n = 48) under continuous cerebral perfusion with an arrested heart.
Results: There were three hospital mortalities. A transient neurologic complication occurred in 3 patients, who recovered completely. During a mean (±standard deviation) of 37.9 ± 26.3 months (range, 0.5 to 95.4 months) of follow-up, 2 late deaths occurred without abnormal neurologic development. Group A had less myocardial ischemic time, 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 than group B, particularly in neonates and patients with complex anomalies.
Conclusions: One-stage total arch repair under regional cerebral perfusion provides an excellent means of minimizing neurologic complications during long-term follow up. Our perfusion strategy 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.
Related Article
Ann. Thorac. Surg. 2010 90: 57.
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J. P. Jacobs Invited Commentary Ann. Thorac. Surg., July 1, 2010; 90(1): 57 - 57. [Full Text] [PDF]
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