Innominate Artery Cannulation and Antegrade Cerebral Perfusion for Aortic Arch Reconstruction in Infants and Children

Nasirov, Teimour; Mainwaring, Richard D.; Reddy, V. Mohan; Sleasman, Justin; Margetson, Tristan; Hanley, Frank L.

doi:10.1177/2150135113497767

Cited by 12 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The innominate artery has increased in popularity as a cannulation site [7] [8]. The safety and efficacy of innominate artery cannulation was demonstrated by Nasirov et al in a retrospective review of 42 pediatric patients undergoing aortic arch surgery [1]. There were no operative mortalities or evidence of clinical neurologic injury.…”

Section: Discussionmentioning

confidence: 99%

“…Innominate artery cannulation provides a safe and easily reproducible alternative and prevents many of the disadvantages seen in femoral and axillary artery cannulation. Its use in pediatric cardiac surgery has seen a rise [1]. Herein, we describe the technique for innominate artery cannulation in pediatric patients undergoing redo sternotomy and review our experience with the technique.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

Ran¹,

Schultz²,

Patel³

et al. 2016

WJCS

View full text Add to dashboard Cite

Redo sternotomy in pediatric patients can be complicated due to the unsuitability of many arterial cannulation sites for the pediatric population. Innominate artery cannulation provides a safe and easily reproducible alternative and prevents many of the disadvantages seen in femoral and axillary artery cannulation. Its use in pediatric cardiac surgery has seen a rise [1]. Herein, we describe the technique for innominate artery cannulation in pediatric patients undergoing redo sternotomy and review our experience with the technique.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

Ran¹,

Schultz²,

Patel³

et al. 2016

WJCS

View full text Add to dashboard Cite

show abstract

“…Although the cited literature varies widely in range for ACP from 10 to 100 mL/kg/min, studies utilizing NIRS technology or visual light spectroscopy have indicated that ACP flow rates of greater than 30 mL/kg/min are sufficient to maintain adequate cerebral and somatic oxygen saturations (12,19,40). Admittedly, these findings must be evaluated within the context of temperature and blood gas management (pH versus alpha stat) among other factors.…”

Section: Discussionmentioning

confidence: 99%

“…In newborns and infants, extended end-to-end repair of coarctation is performed routinely at near-normothermia with all cerebral and systemic perfusion achieved via the innominate artery for periods of approximately 20 minutes, without clinically significant neurological or end-organ injury (17). Notwithstanding, few reports evaluate the use of moderate hypothermia for ACP in neonates and children undergoing aortic arch reconstructions (11,12,(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine

et al. 2016

View full text Add to dashboard Cite

Background: Antegrade cerebral perfusion (ACP) typically is used with deep hypothermia for cerebral protection during aortic arch reconstructions. The impact of ACP on cerebral oxygenation and serum creatinine at a more tepid 25 ℃ was studied in newborns and children.Methods: Between 2010 and 2014, 61 newborns and children (<5 years old) underwent aortic arch reconstruction using moderate hypothermia (25.0±0.9 ℃) with ACP and a pH-stat blood gas management strategy. These included 44% Norwood-type operations, 30% isolated arch reconstructions, and 26% arch reconstructions with other major procedures. Median patient age at surgery was 9 days (range, 3 days-4.7 years). Cerebral oxygenation (NIRS) was monitored continuously perioperatively for 120 hours.Serum creatinine was monitored daily.Results: Median cardiopulmonary bypass (CPB) and cross clamp times were 181 minutes (range, 82-652 minutes) and 72 minutes (range, 10-364 minutes), respectively. ACP was performed at a mean flow rate of 46±6 mL/min/kg for a median of 48 minutes (range, 10-123 minutes). Cerebral and somatic NIRS were preserved intraoperatively and remained at baseline postoperatively during the first 120 hours.Peak postoperative serum creatinine levels averaged 0.7±0.3 mg/dL for all patients. There were 4 (6.6%) discharge mortalities. Six patients (9.8%) required ECMO support. Median postoperative length of hospital and intensive care unit (ICU) stay were 16 days(range, 4-104 days) and 9 days (range, 1-104 days), respectively. Two patients (3.3%) received short-term peritoneal dialysis for fluid removal, and none required hemodialysis. Three patients (4.9%) had an isolated seizure which resolved with medical therapy, and none had a neurologic deficit or stroke.Conclusions: ACP at 25 ℃ preserved perioperative cerebral oxygenation and serum creatinine for newborns and children undergoing arch reconstruction. Early outcomes are encouraging, and additional study is warranted to assess the impact on late outcomes.

show abstract

“…7 A number of techniques have been described for selective antegrade cerebral perfusion. 3,4,8,9 Indirect cannulation involves anastomosing a length of tube graft to the innominate artery, but this increases the complexity of the operation, may cause continuous blood loss from the anastomosis, and possibly provides poorer flow rates. Others have used direct distal ascending aortic cannulation, advancing the cannula into the innominate artery while the anastomosis is performed, but this risks damage to the intima of the innominate artery and is obtrusive when performing a delicate aortic anastomosis in a small neonate.…”

Section: Introductionmentioning

confidence: 99%

Direct Arterial Cannulation Allows Easy and Safe Continuous Selective Cerebral Perfusion During Repair of Interrupted Aortic Arch Even for Low Birth Weight Neonates

Chen

Caputo

Stoica

et al. 2019

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Objectives: To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight. Methods: Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated. Results: Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications. Conclusions: Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.

show abstract

Innominate Artery Cannulation and Antegrade Cerebral Perfusion for Aortic Arch Reconstruction in Infants and Children

Abstract: Innominate artery cannulation is a safe and effective technique for aortic arch reconstruction in nonneonates. We conclude that antegrade cerebral perfusion is a useful technique for aortic arch reconstruction in this patient population.

Cited by 12 publications

References 32 publications

Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

Innominate Artery Cannulation Access in Pediatric Patients Undergoing Redo Sternotomy

Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine

Direct Arterial Cannulation Allows Easy and Safe Continuous Selective Cerebral Perfusion During Repair of Interrupted Aortic Arch Even for Low Birth Weight Neonates

Contact Info

Product

Resources

About