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Introduction
The incidence of aortic arch pathology in older children is rare. Most often this
occurs as a result of a previous aortic arch operation and less often it could be
detected primarily. Previously, we successfully used normothermic perfusion during
neonatal aortic arch repair. In this paper we evaluate the effectiveness of the method
of selective whole body perfusion with coronary perfusion on the beating heart during
aortic arch reconstruction in older children.
Methods
Between October 2019 and February 2021, 3 children underwent aortic arch surgery at
our institution using the defined protocol. During the cardiopulmonary bypass (CPB),
antegrade cerebral perfusion (ACP), antegrade coronary perfusion on beating heart
and distal retrograde femoral aortic perfusion at a constant blood temperature 36
C were used. During the surgery, cerebral and visceral perfusion were monitored using
near-infrared spectroscopy (NIRS) and transcranial dopplerography, electrocardiography
and arterial blood gases. The data was collected prospectively.
Results
Patient one. Male, 6 years old, 27 kg. Elective admission. Diagnosis: Aortic arch
hypoplasia. Surgery: Aortic arch reconstruction.
CPB: Normothermic. Selective ACP, antegrade coronary perfusion on beating heart and
distal retrograde femorall aortic perfusion. Flow 2,5 l/min. CPB time – 78 min, ACP
– 44 min. BCA cannula – 14 fr, coronary cannula – 4fr, femoral artery cannula – 10
fr. Ultrafiltration during CPB.
Mechanical ventilation - 18 hours post/op. Blood lactate 6 hours post/op – 1,8 mmol/l.
ICU admission – 24 hours. Hospital discharge 12 days.
Patient two, 17 y.o., 38 kg. Elective admission. Diagnosis: Aortic arch hypoplasia.
The history of coarctation of the aorta surgery. Surgery: Aortic arch reconstruction.
CPB: Normothermic. Selective ACP, antegrade coronary perfusion on beating heart and
distal retrograde femorall aortic perfusion. Flow 2,5 l/min. CPB time – 136 min, ACP
time – 54 min. BCA cannula – 14 fr, coronary cannula – 4fr, femoral artery cannula
– 15 fr. Ultrafiltration during CPB.
Mechanical ventilation – 4 hours post/op. Blood lactate 6 hours post/op – 2,6 mmol/l.
ICU admission – 16 hours. Hospital discharge 17 days.
Patient three. Female, 4 years old, 15 kg. Admitted urgently. Diagnosis: Critical
aortic arch stenosis. Brachiocephalic artery (BCA) and left common carotid artery
(LCCA) stenosis. The history of coarctation of the aorta surgery. Low ejection fraction.
Surgery: Aortic arch, BCA and LCCA repair.
CPB: Normothermic. Selective ACP, antegrade coronary perfusion on beating heart and
distal retrograde femorall aortic perfusion. Flow 3 l/min. CPB time – 107 min, ACP
– 68 min. BCA cannula – 12 fr, coronary cannula – 4fr, femoral artery cannula – 12
fr. Ultrafiltration during CPB.
Mechanical ventilation - 44 hours post/op. Blood lactate 6 hours post/op – 1,6 mmol/l.
ICU admission – 5 days. Hospital discharge 26 days.
During surgery, laboratory and instrumental parameters were within reference values.
Patients had no neurological deficiency during hospital stage.
Discussion
These clinical cases show that the whole-body perfusion with coronary perfusion on
beating heart provide safe conditions during aortic arch surgery in children using
normothermia. Using this protocol, we were able to eliminate risk factors: circulatory
arrest, hypothermia, cardioplegia, extended
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© 2021 Published by Elsevier Inc.
