Neck cannulation for bypass in redo sternotomy in children and adults with congenital heart disease

Abstract

<jats:title>Abstract</jats:title> <jats:p /> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>Patients with complex congenital heart disease carry an increased risk of damage to retrosternal structures each time they undergo redo sternotomy. The aim of this study was to evaluate the safety and efficacy of neck cannulation for peripheral cardiopulmonary bypass to alleviate the risks in high-risk redo sternotomy patients.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Children and adults with congenital heart disease undergoing high-risk redo sternotomy were included in this retrospective study. The primary outcome was the safety and efficacy of neck cannulation for cardiopulmonary bypass. The secondary outcome was to assess preoperative risk factors as an indication for neck cannulation. The right common carotid artery and right internal jugular vein were cannulated and full cardiopulmonary bypass was initiated with vacuum-assisted venous drainage. Redo sternotomy was performed on a decompressed heart, and bifrontal regional cerebral oxygen saturation was monitored via near-infrared spectroscopy.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In total, 35 patients were included. No mortality, neurological or vascular complications occurred postoperatively. Mean left- and right-sided near-infrared spectroscopy were 70.0% (±10.5) and 64.2% (±12.0), respectively, and the mean difference was 5.7% (±6.9). Main preoperative risk factors were; adherent ascending aorta (45.7%), adherent conduit (40%), severely dilated retrosternal right ventricle (17.1%) and skeletal deformations (14.3%).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Cannulation of the right neck vessels for peripheral cardiopulmonary bypass prior to high-risk redo sternotomy in children and adults with congenital heart disease is a safe and effective strategy. In combination with near-infrared spectroscopy monitoring, adequate cerebral oxygenation can be ensured while the risk of catastrophic haemorrhage is minimized.</jats:p> </jats:sec>

Coronary aneurysms, myocardial dysfunction, and shock in a COVID-19 child, role of ECMO, immunomodulation, and cardiac CT

“…We used bilateral near-infrared spectroscopy monitoring to assess for adequate cerebral oxygenation. 8 Appropriate anticoagulation is of importance as high fibrinogen and d-dimers in this syndrome suggest an increased risk of hypercoagulability, of particular concern in patients receiving extracorporeal membrane oxygenation in whom the risk of thrombotic events is already significant. 9,10 During the COVID-19 pandemic, a large cohort of children with multisystem inflammatory syndrome in children with cardiac involvement were managed at Evelina London Children's Hospital.…”

Ascending aortic pseudoaneurysm following Norwood Stage 1 surgery in an infant

“…The use of various perfusion techniques during sternal re-entry has been reported in paediatric patients. 2,3,7 We cannulated the common carotid artery and the internal jugular vein prior to opening the chest in our patient. Neck cannulation is a well-known and useful technique in paediatric patients with small femoral arteries and veins and is effective by inserting a large enough cannula to initiate cardiopulmonary bypass.…”

“…Neck cannulation is a well-known and useful technique in paediatric patients with small femoral arteries and veins and is effective by inserting a large enough cannula to initiate cardiopulmonary bypass. 7 With the support of cardiopulmonary bypass, the heart and the ascending aorta became decompressed. The sternal re-entry was uneventful with careful dissection of surrounding tissue of the ascending aorta and pseudoaneurysm.…”