Nasirov Teimour, Mainwaring Richard D, Reddy V Mohan, Sleasman Justin, Margetson Tristan, Hanley Frank L
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
World J Pediatr Congenit Heart Surg. 2013 Oct;4(4):356-61. doi: 10.1177/2150135113497767.
Innominate artery cannulation has been widely adopted as a means to perform aortic arch reconstruction with continuous cerebral perfusion in the newborn. Although this technique has been subsequently utilized in infants and children, there is currently no data regarding the safety or efficacy in these older children. The purpose of this study was to review our experience with innominate artery cannulation for aortic arch reconstruction in patients beyond the neonatal period.
This was a retrospective review of 42 infants and children who underwent aortic arch reconstruction using the technique of innominate artery cannulation with continuous cerebral perfusion. Of these procedures, 29 (69%) were primary arch reconstructions, while 13 (31%) were aortic arch reoperations. The median age at surgery was 8 months, and 22 patients underwent concomitant intracardiac repairs.
There was no operative mortality in this cohort of 42 patients undergoing aortic arch reconstruction. There was also no overt evidence of neurologic injury. Specifically, none of the patients demonstrated a neurologic deficit, clinical seizure, or unexpected delay in regaining a normal state of consciousness. The median duration of antegrade cerebral perfusion was 34 minutes. The median duration of hospital stay was 11 days. No patient required reoperation on the aortic arch with a median of 45-month follow-up.
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.
无名动脉插管已被广泛用作新生儿主动脉弓重建并持续脑灌注的一种方法。尽管该技术随后也应用于婴幼儿，但目前尚无关于其在较大儿童中的安全性或有效性的数据。本研究的目的是回顾我们在新生儿期后的患者中使用无名动脉插管进行主动脉弓重建的经验。
这是一项对42例婴幼儿进行的回顾性研究，这些患儿采用无名动脉插管技术并持续脑灌注进行主动脉弓重建。在这些手术中，29例（69%）是初次弓重建，而13例（31%）是主动脉弓再次手术。手术时的中位年龄为8个月，22例患者同时进行了心内修复。
在这42例接受主动脉弓重建的患者队列中无手术死亡。也没有明显的神经损伤证据。具体而言，没有患者出现神经功能缺损、临床癫痫发作或恢复正常意识状态的意外延迟。顺行性脑灌注的中位持续时间为34分钟。住院时间的中位值为11天。在中位随访45个月时，没有患者需要对主动脉弓再次手术。
无名动脉插管是一种用于非新生儿主动脉弓重建的安全有效的技术。我们得出结论，顺行性脑灌注是该患者群体主动脉弓重建的一种有用技术。
