Chen Qiang, Caputo Massimo, Stoica Serban, Lansdowne William, Parry Andrew J
1 Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom.
2 Department of Perfusion, Bristol Royal Hospital for Children, Bristol, United Kingdom.
World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):464-468. doi: 10.1177/2150135119846824.
To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight.
Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated.
Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications.
Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.
回顾连续队列中不论体重的新生儿经无名动脉直接插管进行持续脑灌注以修复主动脉弓中断（IAA）的结果。
1999年9月至2016年4月期间，44例IAA患儿（18例A型和26例B型）通过经无名动脉直接插管进行持续低温（18°C）低流量脑灌注进行修复。相关心脏病变包括永存动脉干（TA；5例）、室间隔缺损（VSD；30例）、大动脉转位（TGA；1例）、不平衡房室间隔缺损（1例）、双入口左心室（1例）、双出口右心室（3例）和主肺动脉窗（APW；5例）。永存动脉干、单一室间隔缺损、大动脉转位和主肺动脉窗得到矫正，而其他患者进行姑息治疗。
手术时年龄为7天（4 - 120天），体重3.1 kg（2.1 - 5.8 kg）。所有患者均维持选择性脑灌注。在选择性脑灌注期间，灌注流速维持在30 mL/kg/min。主动脉阻断时间、低流量和总体外循环时间分别为63（40 - 116）分钟、28（17 - 41）分钟和108（80 - 217）分钟。无死亡病例，也无神经损伤的临床证据。术后通气时间、重症监护病房住院时间和住院时间分别为3（2 - 14）天、5（3 - 21）天和13（6 - 27）天。随访至84个月（24 - 221个月）时，未发现晚期明显的临床神经后遗症或无名动脉并发症。
即使在低体重新生儿中，经无名动脉直接插管并进行持续选择性脑灌注可安全用于IAA修复。该技术操作简单，临床效果良好。
