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Introduction
The incidence of aortic dissection in 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 during aortic arch reconstruction in older children.
Methods
In November 2020, we performed a reconstructive aortic arch surgery at our institution
using the defined protocol. During the cardiopulmonary bypass (CPB), antegrade cerebral
perfusion (ACP), distal retrograde femoral aortic perfusion at a constant blood temperature
36 C and cardioplegia. During the surgery, cerebral and visceral perfusion was monitored
using near-infrared spectroscopy (NIRS) and transcranial dopplerography, electrocardiography
and arterial blood gases. The data was collected prospectively.
Results
Female patient, 15 y.o., 60 kg. Elective admission. Diagnosis: Chronic aortic dissection,
DeBakey type I. The history of patient ductus arteriosus surgery (1 y.o.).
Surgery: Ascending aortic aneurysm resection and supracoronary aortic arch reconstruction
using vascular graft. CPB: Normothermia. Cardioplegia: Custodiol. ACP and distal retrograde
femoral aortic perfusion. Flow 2,5 l/min. CPB time – 186 min, ACP time – 89 min. BCA
cannula – 16 fr, femoral artery cannula – 15 fr. Ultrafiltration during CPB.Mechanical
ventilation – 3,5 hours post/op. Blood lactate 6 hours post/op – 3 mmol/l. ICU admission
– 18 hours. Hospital discharge 15 days. During surgery, laboratory and instrumental
parameters were within reference values. The patient had no neurological deficiency
during hospital stage. Stenting of thoracic and abdominal aorta is planned further.
Discussion
This clinical case shows that the whole-body perfusion provide safe conditions during
aortic arch surgery in children using normothermia. Using this protocol, we were able
to eliminate a lot of risk factors: circulatory arrest, hypothermia, extended CPB
time and reperfusion injury.
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Copyright
© 2021 Published by Elsevier Inc.
