SHA 047. Mid-term outcome of single-stage repair of interrupted aortic arch using antegrade selective cerebral perfusion

Abstract OBJECTIVES The outcomes of the single-stage surgical repair of aortic arch hypoplasia (AAH) and/or coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remain controversial, especially in a lower middle-income country. This study reports the results of a single-stage repair protocol at our institution for AAH/CoA with VSD using selective cerebral perfusion. METHODS This retrospective study included 100 consecutive patients who underwent single-stage repair via median sternotomy using selective cerebral perfusion for AAH/CoA with VSD from July 2010 to March 2017. RESULTS The patients consisted of 65 males and 35 females. The median age of the patients was 67 days (range 4–2266 days); the median weight was 3.8 kg (range 2.1–15 kg). The average cardiopulmonary bypass time was 132 ± 28 min, the aortic cross-clamp time was 92 ± 23 min and the selective cerebral perfusion time was 33 ± 10 min. The survival rate of all patients was 94.7 ± 2.3%, with an in-hospital mortality of 5% and no late mortality at a median follow-up of 37 months (range 4–96 months). Four patients required reoperation due to recoarctation. The overall event-free survival rate following surgery was 87.1%. The median pressure gradient across the anastomosis at the last follow-up was 8.3 ± 2.8 mmHg. Multivariate logistic regression analysis revealed proximal aortic arch obstruction as a predictor of mortality (odds ratio = 3.8). The aortic isthmus diameter was identified as a predictor for reintervention by Cox regression (hazard ratio = 6.7). CONCLUSIONS Single-stage repair for AAH/CoA with VSD is safe and feasible in a developing country.

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A simplified technique for antegrade selective cerebral perfusion

Perfusion ◽

10.1191/0267659102pf569oa ◽

2002 ◽

Vol 17 (3) ◽

pp. 187-189 ◽

Cited By ~ 3

Author(s):

N Colangelo ◽

S Benussi ◽

G Piazza ◽

O Alfieri

Keyword(s):

Blood Flow ◽

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Extracorporeal Circuit ◽

Selective Cerebral Perfusion ◽

Modified Technique ◽

Roller Pump ◽

Set Up ◽

Antegrade Selective Cerebral Perfusion

Various methods of cerebral protection have been used during aortic arch surgery. We reviewed our experience with a modified technique for selective cerebral perfusion (SCP) administration during surgery on the thoracic aorta from October 1999. Conventionally, this technique requires an additional roller pump on the cardiopulmonary bypass (CPB) console. In order to simplify the extracorporeal circuit (ECC), the paediatric double-roller pump used for the administration of cardioplegia was utilized by adding a ‘Y-connection’ on the blood line of the cardioplegia circuit, upstream of the cardioplegia reservoir, to provide SCP blood flow. SCP administration with a Y-connection is both easy and fast to set up on the ECC circuit and does not create additional difficulties to the surgeon. It simplifies SCP delivery by allowing the perfusionist to use a standard ECC system set-up.

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