Primary Repair for Aortic Arch Obstruction Associated With Ventricular Septal Defect

Kostelka, Martin; Walther, Thomas; Geerdts, Imke; Rastan, Ardawan; Jacobs, Stefan; Dähnert, Ingo; Kiefer, Herbert; Bellinghausen, Wilfried; Mohr, Friedrich W.

doi:10.1016/j.athoracsur.2004.05.018

Cited by 38 publications

(36 citation statements)

References 9 publications

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“…Overall hospital morbidity in the present study was in line with prior observations on neonatal arch repair, when not lower . Furthermore, cardiac morbidity was significantly lower in patients having selective CMP.…”

Section: Discussionsupporting

confidence: 91%

“…Prior evidence on CMP in neonatal arch surgery is limited. Kostelka et al showed that CMP, albeit with great variability in perfusion flows and temperatures, was associated with no hospital mortality in a select series of 19 neonates having biventricular repair. Later work by Oppido and colleagues observed significant mortality (13%) in 39 neonates having arch repair CMP using standardized flows (10‐20 mL/kg/min) and temperature (25°C).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies showed the feasibility and safety of combining ACP with myocardial perfusion with the goal of reducing, when not avoiding at all, the duration of myocardial ischemia in a variety of pediatric cardiac surgical scenarios . More recently, an alternative and novel strategy for selective cerebro‐myocardial protection was developed, where ACP is associated with controlled and independent coronary perfusion .…”

Section: Introductionmentioning

confidence: 99%

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Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

et al. 2019

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The results of neonatal aortic arch surgery using cerebro‐myocardial perfusion were analyzed. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard perfusion, using a single pump rotor with an arterial line Y‐connector. Between May 2008 and May 2016, 69 consecutive neonates underwent arch repair using either selective cerebro‐myocardial perfusion (Group A, n = 34) or standard perfusion (Group B, n = 35). The groups were similar for age, weight, BSA, prevalence of one‐stage or staged repair, and single ventricle palliation; male gender was more frequent in Group A. The duration of the cerebro‐myocardial perfusion was comparable (27 ± 8 vs. 28 ± 7 min, P = 0.9), with higher flows in Group A (57 ± 27 vs. 39 ± 19 mL/kg/min, P = 0.01). Although cardioplegic arrest was more common in Group B (13/34 vs. 23/35, P = 0.03), the duration of myocardial ischemia was longer in Group A (64 ± 41 vs. 44 ± 14 min, P = 0.04). There was 1 hospital death in each group, with no permanent neurological injury in either group. Cardiac morbidity (1/34 vs. 7/35, P = 0.02) was more common in Group B, while extracardiac morbidity was similar in both the groups. During follow‐up (3.2 ± 2.4 years), 5 late deaths occurred with a comparable 5‐year survival rate (75 ± 17% vs. 88 ± 6%, P = 0.7) and freedom from arch reintervention (86 ± 6% vs. 84 ± 7%, P = 0.6). Risk of cardiac morbidity was greater with standard cerebro‐myocardial perfusion (OR = 5.2, CI 3.3–6.8, P = 0.001) and with perfusion flows less than 50 mL/kg/min (OR 3.7, CI 1.87–5.95, P = 0.04). Cerebro‐myocardial perfusion is a safe and effective strategy to protect the brain and heart in neonates undergoing arch repair. Selective techniques using higher perfusion flows may further attenuate cardiac morbidity.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

et al. 2019

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“…[7] Since the early report of balloon angioplasty by Labibidi in 1984, many reports of balloon angioplasty or stenting in the newborns or young infants with varying results have been published with few operators recommending the procedure, while others preferring surgery against angioplasty. [8‐12] In our series, all patients had significant reduction in gradients with only a few procedural complications. Diameter of balloon for dilatation was selected depending on the isthmus dimension and maximum balloon size was limited by the dimensions of transverse arch.…”

Section: Discussionmentioning

confidence: 69%

Emergency balloon dilation or stenting of critical coarctation of aorta in newborns and infants: An effective interim palliation

et al. 2009

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Background:Management of native uncomplicated coarctation in neonates remains controversial with current evidence favoring surgery. The logistics of organizing surgical repair at short notice in sick infants with critical coarctation can be challenging.Methods and Results:We reviewed data of 10 infants (mean age of 2.9 ±1.6 weeks) who underwent catheter intervention for severe coarctation and left ventricular (LV) dysfunction between July 2003 and August 2007. Additional cardiac lesions were present in 7. Mean systolic gradient declined from 51±12 mm Hg to 8.7±6.7 mm Hg after dilation. The coarctation segment was stented in five patients. Procedural success was achieved in all patients with no mortality. Complications included brief cardiopulmonary arrest (n =1), sepsis (n = 1) and temporary pulse loss (n = 2). LV dysfunction improved in all patients. Average ICU stay was 5±3.4 days and hospital stay was 6.5±3.4 days. On follow-up (14.1±10.5 months), all developed restenosis after median period of 12 weeks (range four to 28 weeks). Three (two with stents) underwent elective coarctation repair, two underwent ventricular septal defect (VSD) closure and coarctation repair and one underwent pulmonary artery (PA) banding. Two patients who developed restenosis on follow-up were advised surgery, but did not report. Two (one with stent) underwent redilatation and are being followed with no significant residual gradients.Conclusion:Balloon dilation ± stenting is an effective interim palliation for infants and newborns with critical coarctation and LV dysfunction. Restenosis is inevitable and requires to be addressed.

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“…We wish to thank Ji and associates from Beijing for their kind comments and inquiries. Although no controlled study currently exists showing superiority in terms of cerebral protection of antegrade cerebral perfusion (ACP) during moderate or deep hypothermic circulatory (splanchnic) arrest (DHCA), retrospective clinical series, including our own, have suggested non‐inferiority when compared to DHCA alone (1–4). In addition, some methods have been proposed to add continuous coronary perfusion to ACP as a means to ensure optimal myocardial protection (2–4).…”

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confidence: 99%

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Primary Repair for Aortic Arch Obstruction Associated With Ventricular Septal Defect

Cited by 38 publications

References 9 publications

Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

Emergency balloon dilation or stenting of critical coarctation of aorta in newborns and infants: An effective interim palliation

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