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Antegrade regional cerebral perfusion

Published online by Cambridge University Press:  21 September 2005

Christo I. Tchervenkov ,
Abdulaziz Al-Khaldi  and
Dominique Shum-Tim
Christo I. Tchervenkov
Affiliation:
The Division of Cardiovascular Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
Abdulaziz Al-Khaldi
Affiliation:
The Division of Cardiovascular Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
Dominique Shum-Tim
Affiliation:
The Division of Cardiovascular Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
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Extract

A quiet and bloodless field providing optimal surgical conditions has been a crucial prerequisite for the performance of complex cardiac repairs in early life. The use of deep hypothermic circulatory arrest has fulfilled this role, and has been a catalyst for the development of neonatal and infant cardiac surgery. The recently increased awareness of possibly increased incidence of adverse neurological events and developmental outcome associated with this technique,1–5 however, has led to a general trend away from its use. In its place, techniques have been developed to provide cerebral perfusion during reconstruction of the aortic arch and the Norwood operation. Some have described the techniques as regional low-flow perfusion. In our opinion, they are described more accurately as antegrade regional cerebral perfusion. In this review, we discuss the recently described techniques for such antegrade regional cerebral perfusion during surgery on the aortic arch, with emphasis both on the Norwood operation and the observed physiological changes in the cerebral and systemic circulations. The neurologic and developmental outcomes following the use of the technique are still unknown.

Type
Norwood Procedure and Staged Palliation
Information
Cardiology in the Young , Volume 14 , Issue S1 , February 2004 , pp. 70 - 74
Copyright
© 2004 Cambridge University Press

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References

Swain JA, McDonald TJ Jr, Griffith PK, Balaban RS, Clark RE, Ceckler T. Low-flow hypothermic cardiopulmonary bypass protects the brain. J Thorac Cardiovasc Surg 1991; 102: 76–84.Google Scholar
Newburger JW, Jonas RA, Wernovsky G, Wypij D, Hickey PR, Kuban KC, Farrell DM, Holmes GL, Helmers SL, Constantinou J, Carrazana E, Barlow JK, Walsh AZ, Lucius KC, Share JC, Wessel DL, Hanley FL, Mayer JE Jr, Castaneda AR, Ware JH. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. NEJM 1993; 329: 1057–1064.Google Scholar
Bellinger DC, Jonas RA, Rappaport LA, Wypij D, Wernovsky G, Kuban KC, Barnes PD, Holmes GL, Hickey PR, Strand RD, Walsh AZ, Helmers SL, Constantinou JE, Carrazana EJ, Mayer JE, Hanley FL, Castaneda AR, Ware JH, Newburger JW. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. NEJM 1995; 332: 549–555.Google Scholar
Sakurada T, Kazui T, Tanaka H, Komatsu S. Comparative experimental study of cerebral protection during aortic arch reconstruction. Ann Thorac Surg 1996; 61: 1348–1354.Google Scholar
Hickey PR. Neurologic sequelae associated with deep hypothermia circulatory arrest. Ann Thorac Surg 1998; 65: S65–S70, S74–S76.Google Scholar
Asou T, Kado H, Imoto Y, Shiokawa Y, Tominaga R, Kawachi Y, Yasui H. Selective cerebral perfusion technique during aortic arch repair in neonates. Ann Thorac Surg 1996; 61: 1546–1548.Google Scholar
Asou T, Yasui H, Kado H, Imoto Y, Shiokawa KF, Tominaga R, Kawachi Y. The use of a newly developed pediatric arterial perfusion cannula for neonates. Cardiol Young 1997; 7: 71–73.Google Scholar
Tchervenkov CI, Chu VF, Shum-Tim D, Laliberte E, Reyes TU. Norwood operation without circulatory arrest: a new surgical technique. Ann Thorac Surg 2000; 70: 1730–1733.Google Scholar
Tchervenkov CI, Korkola SJ, Shum-Tim D. Surgical technique to avoid circulatory arrest and direct arch vessel cannulation during neonatal aortic arch reconstruction. Eur J Cardiothorac Surg 2001; 19: 708–710.Google Scholar
Tchervenkov CI, Korkola SJ, Shum-Tim D, Calaritis C, Laliberte E, Reyes TU, Lavoie J. Neonatal aortic arch reconstruction avoiding circulatory arrest and direct arch vessel cannulation. Ann Thorac Surg 2001; 72: 1615–1620.Google Scholar
Imoto Y, Kado H, Shiokawa Y, Fukae K, Yasui H. Norwood procedure without circulatory arrest. Ann Thorac Surg 1999; 68: 559–561.Google Scholar
Imoto Y, Kado H, Shiokawa Y, Minami K, Yasui H. Experience with the Norwood procedure without circulatory arrest. J Thorac Cardiovasc Surg 2001; 122: 879–882.Google Scholar
Ishino K, Kawada M, Irie H, Kino K, Sano S. Single-stage repair of aortic coarctation with ventricular septal defect using isolated cerebral and myocardial perfusion. Eur J Cardiothorac Surg 2000; 7: 538–542.Google Scholar
Pigula FA, Nemoto EM, Griffith BP, Sieweers RD. Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg 2000; 119: 331–339.Google Scholar
Andropoulos DB, Stayer SA, McKenzie ED, Fraser CD Jr. Novel cerebral physiologic monitoring to guide low-flow cerebral perfusion during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg 2003; 125: 491–499.Google Scholar
Pigula FA, Gandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM. Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery. Ann Thorac Surg 2001; 72: 401–407.Google Scholar
DeCampli WM, Schears G, Myung R, Schultz S, Creed J, Pastuszko A, Wilson DF. Tissue oxygen tension during regional low-flow perfusion in neonates. J Thorac Cardiovasc Surg 2003; 125: 472–480.Google Scholar