Results With All Blood Retrograde Microplegia as a Myocardial Protection Strategy for Complex Neonatal Arch Reconstruction

Abstract

Neonatal arch reconstructions present a challenge for myocardial protection. We report our results for eight patients treated with intermittent cold all blood retrograde cardioplegia during arch reconstruction using continuous selective normothermic cerebral perfusion. Over a 10-month period eight consecutive neonates underwent complex arch reconstruction. Mean age was 8.4 days (range 2-23); weight 3.1 kg (range 2.7-3.8). Diagnosis was hypoplastic left heart syndrome (5), interrupted aortic arch/ventriculoseptal defect (2), and complex AP window (1). Mean cardiopulmonary bypass time was 149 minutes (range 80-201), mean cross-clamp time was 74 (range 51-101). All patients had primary chest closure and none required extra-corporeal membrane oxigenation. One patient (12%) had a period of low cardiac output syndrome, which resolved with high dose inotropes. All patients were discharged alive and well. Intermittent all blood retrograde microplegia is an effective myocardial protection strategy for complex neonatal arch reconstruction. Postoperative myocardial function is very good. This protection approach facilitates continuous selective normothermic cerebral perfusion.

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

“…Data collected from instances in which HTK solution has been used for high-risk patients with complex congenital heart disease remains rare (19)(20)(21)(22). A study of Fuwai Hospital compared the myocardial protective effect induced by HTK solution and conventional St. Thomas crystalloid cardioplegia on the long-term ischemic period (cross-clamping time, >90 min) during severe complex pediatric cardiac surgery without pulmonary arterial hypertension.…”

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

“…Surgery for aortic arch reconstruction with aortic coarctation can be performed with various surgical approaches for cardiopulmonary bypass. Deep hypothermia and circulatory arrest ( 32 – 34 ) has been progressively replaced by regional cerebral perfusion ( 35 – 38 ) with or without associated myocardial perfusion and beating heart ( 39 , 40 ), and more recently with distal aortic cannulation for lower body perfusion ( 41 – 43 ). Our standard approach was to use regional cerebral and myocardial perfusion with aortic cross clamping and myocardial ischemia only for the repair of the associated intra-cardiac defects, but we do not consider this matter relevant for the surgical results related to this study.…”

Histidine-tryptophan-ketoglutarate solution decreases mortality and morbidity in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease: an 11-year experience from a single institution

“…Studies with sufficient number of patients and adequate postoperative measurements to detect significant adverse effects of cardioplegia for high-risk patients with complex congenital heart disease are lacking ( 1 , 16 , 17 ). Data on the use of the HTK solution in these patients are rare ( 18 , 19 ).…”