Single-stage repair of aortic arch and associated cardiac defects with antegrade cerebral perfusion using direct innominate artery cannulation in neonates and infants

Dharmapuram, Anil Kumar; Ramakrishnan, Nagarajan; Goutami, Vejendla; Mantri, Narsimulu; Turner, Shishir Pravin; Vuppali, Nanda Kishor Kumar; Koyalakonda, Chandra Shekhar; Pooboni, Suneel; Rao, Ivatury

doi:10.1007/s12055-015-0367-4

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…20, 21, 22 To prevent this, we have adopted to use selective cerebral perfusion during arch repair in neonates and infants, and our outcomes have been published without neurological injury or seizure activity in these babies. 15…”

Section: Discussionmentioning

confidence: 99%

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Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

Dharmapuram

Ramakrishnan

Goutami

et al. 2020

Indian Journal of Clinical Cardiology

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Background: Complex cardiac surgery in neonates and small-weight babies is a challenge. In addition to the surgical expertise and skill required, accurate diagnosis, management of anesthesia, perfusion, and postoperative critical care are equally challenging. Methods: We have analyzed the data of 4 different examples of complex cardiac surgery in neonates and small-weight babies from February 2012 to July 2019 in our unit. The first group included 118 cases of arterial switch operations for transposition of great arteries with and without ventricular septal defect (group 1). The second group included 52 patients of aortic arch repair from midline using selective cerebral perfusion avoiding total circulatory arrest (group 2). The third group included 75 patients of repair of coarctation of aorta from thoracotomy using the modified end-to-side technique (group 3). The fourth group included 40 neonates and small-weight babies who underwent repair of total anomalous pulmonary venous connection (group 4). Results: In group 1, there was hospital mortality in 6 babies. In group 2, there was no hospital mortality. In group 3, there was 1 hospital death; in group 4, there were 5 hospital deaths. The major contributing cause of death was respiratory or blood-borne infection causing respiratory issues leading to prolonged ventilation. Left diaphragm palsy contributed to morbidity and eventual death in 2 babies. Only 2 patients required tracheostomy to wean off the ventilator. Conclusions: In the present day, it is possible to achieve satisfactory results with acceptable mortality in neonatal cardiac surgery. Morbidity associated with very early repair in neonatal age, low weight, and infection-related issues is manageable with good outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Surgical Technique: This technique has been published from our unit earlier under the title of “Single-stage repair of aortic arch and associated cardiac defects with antegrade cerebral perfusion using direct innominate artery cannulation in neonates and infants.” 15…”

Section: Methodsmentioning

confidence: 99%

Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

Dharmapuram

Ramakrishnan

Goutami

et al. 2020

Indian Journal of Clinical Cardiology

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“…Однако таким способом выполняли пластику дуги аорты только при гипоплазии сегментов А и В дуги аорты. При гипоплазии сегмента С дуги аорты использовали ИК с селективной антеградной церебральной перфузией, что позволяет избежать нестабильной гемодинамики в период пережатия аорты и предотвращает возникновение неврологических осложнений [8,9]. Случаи возникновения повторного стеноза в месте реконструкции дуги аорты в послеоперационном периоде и повторные вмешательства (как эндоваскулярные, так и хирургические) в исследуемой группе были связаны с недостаточным удалением дуктальных тканей в месте пластики дуги аорты.…”

Section:  обсуждениеunclassified

Гипоплазия Дуги Аорты В Сочетании С Другими Врожденными Пороками Сердца У Младенцев: Результаты Одноэтапного Лечения

Труба¹,

Лазоришинець²,

Sekelyk³

et al. 2022

Кардиология В Беларуси

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Введение. Вопрос этапности хирургического лечения гипоплазии дуги аорты в сочетании с другими врожденными пороками сердца (ВПС) остается дискутабельным. Преимущества одноэтапного лечения такого сложного сочетания и хорошие отдаленные результаты делают одноэтапное лечение методом выбора коррекции гипоплазии дуги аорты с сопутствующими ВПС. Цель. Провести анализ непосредственных и отдаленных результатов одноэтапной коррекции гипоплазии дуги аорты в сочетании с другими ВПС у младенцев. Материалы и методы. Группу исследования составили 148 последовательных пациентов неонатального периода, которым выполнена одноэтапная коррекция гипоплазии дуги аорты и сопутствующих ВПС. Пациенты с одножелудочковой физиологией не были включены в исследование. Пациентов мужского пола было 95 (64%), женского - 53 (36%). Средний возраст пациентов составил 1,2±0,5 месяца, средняя масса тела - 3,8±1,1 кг. Сегмент дуги аорты считали гипоплазированным, если отклонение Z-score составляло менее 2,0. Результаты. Госпитальная летальность составила 2,7% (n=4). Причины летальности были связаны с коррекцией сопутствующих ВПС. Длительность искусственного кровообращения в среднем составила 111,4±39,2 мин, время пережатия аорты - 73,4±41,5 мин, время селективной церебральной перфузии - 22,4±7,4 мин. Градиент давления в месте пластики дуги аорты после операции в среднем был 18,2±11,5 мм рт. ст. Продолжительность периода наблюдения составила от 1 месяца до 9,4 года (среднее значение 2,8±2,5 года). В отдаленном периоде летальных случаев не было. У 14 (9,4%) пациентов в послеоперационном периоде развился повторный стеноз на дуге аорты, который был успешно устранен эндоваскулярным или хирургическим путем. Показатель свободы от повторных операций в отдаленном периоде наблюдения через 1 год составил 89,4%, через 4 года и следующие 6 лет оставался постоянным и был 87,5%. Случаев компрессии трахеи, бронхов, неврологических осложнений в отдаленном периоде не наблюдалось. Заключение. Одноэтапная коррекция гипоплазии дуги аорты в сочетании с другими ВПС является эффективным и безопасным методом лечения у младенцев с хорошими непосредственными и отдаленными результатами. Проведенное исследование указывает на то, что данная хирургическая стратегия может быть приемлемой альтернативой двухэтапному хирургическому лечению этой комплексной патологии. Introduction. The question of the stages of surgical treatment of aortic arch hypoplasia in combination with other congenital heart defects (CHD) continues to be debated. The advantages of one-stage treatment of such a complex combination and good long-term results make one-stage treatment the method of choice for correcting hypoplasia of the aortic arch with concomitant CHD. Purpose. To analyze the immediate and long-term results of one-stage repair of aortic arch hypoplasia in combination with other CHD in infants. Materials and methods. The study group consisted of 148 consecutive neonatal patients who underwent one-stage repair of aortic arch hypoplasia and concomitant CHD. Patients with a single ventricular physiology were not included in this study. There were 95 male patients (64%), female - 53 (36%). The average age of the patients was 1.2±0.5 months. (from 0.03 to 12 months), the average body weight was 3.8±1.1 kg (from 2.2 to 7.5 kg). A segment of the aortic arch was considered hypoplastic if the deviation of the Z-score was less than 2.0. Results. Hospital mortality was 2.7% (n=4). The causes of mortality were associated with the correction of concomitant defects. The mean cardiopulmonary bypass time 111.4±39.2 minutes, the mean aortic cross-clamp time was 73.4±41.5 minutes, and the time of selective cerebral perfusion was 22.4±7.4 minutes. The mean pressure gradient at the site of the aortic arch repair was 18.2±11.5 mm Hg. The long-term follow-up ranged from 1 month to 9.4 years (mean 2.8±2.5 years). In the long- term period, there were no deaths. Restenosis on the aortic arch developed in 14 (9.4%) patients in the postoperative period, which was successfully treated endovascular or surgically. The freedom from reoperations in the long-term follow-up period after 1 year was 89.4%, after 4 years and the next 6 years it remained constant at 87.5%. There were no cases of compression of the trachea, bronchi, neurological complications in the long-term period. Conclusion. One-stage repair of the aortic arch hypoplasia in combination with other CHD is an effective and safe method of treatment in infants with good immediate and long-term results. The conducted research indicates that this surgical strategy can be an acceptable alternative to two- stage surgical treatment of this complex pathology.

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“…Various modifications of this approach with the principle of ante grade cerebral perfusion have been described for aortic arch surgeries to avoid DHCA. This has been the technique for establishing SACP (selective ante grade cerebra perfusion) in our centre [38].We have used this technique in 52 patients with weight range of 2.0 to 8.1 kg requiring single-stage repair of aortic arch and associated cardiac defects.…”

Section: Techniques For Avoiding Dhcamentioning

confidence: 99%

Avoiding use of total circulatory arrest in the practice of congenital heart surgery

Ramakrishnan

Dharmapuram

Goutami

et al. 2020

Indian J Thorac Cardiovasc Surg

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Deep hypothermic circulatory arrest (DHCA) technique has been an important armamentarium in the correction of congenital heart diseases. There have been many controversies and concerns associated with DHCA, particularly neurological damage. Selective ante grade cerebral perfusion (SACP) was introduced as an adjunct to DHCA with the objective of limiting the neurologic injury during aortic arch repairs. Over the past two decades, various aspects of cardiopulmonary bypass and DHCA have been studied and modified such as optimisation of flows, anti-inflammatory interventions, haematocrit, and temperature to improve neurologic outcomes. With the changes in practice of DHCA, outcomes have significantly improved but SACP intuitively appears attractive to offer better neuroprotection. The strategy of conduct of SACP is evolving and needs to be standardised for comparing outcomes. In this review we have discussed the various physiological and technical factors involved in conduct of SACP in paediatric cardiac surgery and outcomes with SACP.

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Single-stage repair of aortic arch and associated cardiac defects with antegrade cerebral perfusion using direct innominate artery cannulation in neonates and infants

Cited by 3 publications

References 18 publications

Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

Гипоплазия Дуги Аорты В Сочетании С Другими Врожденными Пороками Сердца У Младенцев: Результаты Одноэтапного Лечения

Avoiding use of total circulatory arrest in the practice of congenital heart surgery

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