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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.
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.
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.
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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