Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK.
Grown-up Congenital Heart Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2020 Jul 1;31(1):108-112. doi: 10.1093/icvts/ivaa045.
Patients with complex congenital heart disease carry an increased risk of damage to retrosternal structures each time they undergo redo sternotomy. The aim of this study was to evaluate the safety and efficacy of neck cannulation for peripheral cardiopulmonary bypass to alleviate the risks in high-risk redo sternotomy patients.
Children and adults with congenital heart disease undergoing high-risk redo sternotomy were included in this retrospective study. The primary outcome was the safety and efficacy of neck cannulation for cardiopulmonary bypass. The secondary outcome was to assess preoperative risk factors as an indication for neck cannulation. The right common carotid artery and right internal jugular vein were cannulated and full cardiopulmonary bypass was initiated with vacuum-assisted venous drainage. Redo sternotomy was performed on a decompressed heart, and bifrontal regional cerebral oxygen saturation was monitored via near-infrared spectroscopy.
In total, 35 patients were included. No mortality, neurological or vascular complications occurred postoperatively. Mean left- and right-sided near-infrared spectroscopy were 70.0% (±10.5) and 64.2% (±12.0), respectively, and the mean difference was 5.7% (±6.9). Main preoperative risk factors were; adherent ascending aorta (45.7%), adherent conduit (40%), severely dilated retrosternal right ventricle (17.1%) and skeletal deformations (14.3%).
Cannulation of the right neck vessels for peripheral cardiopulmonary bypass prior to high-risk redo sternotomy in children and adults with congenital heart disease is a safe and effective strategy. In combination with near-infrared spectroscopy monitoring, adequate cerebral oxygenation can be ensured while the risk of catastrophic haemorrhage is minimized.
患有复杂先天性心脏病的患者每次接受再次胸骨切开术时，胸骨后结构受损的风险都会增加。本研究旨在评估经颈静脉插管进行外周心肺转流术的安全性和有效性，以降低高危再次胸骨切开术患者的风险。
本回顾性研究纳入了接受高危再次胸骨切开术的先天性心脏病儿童和成人患者。主要结局是经颈静脉插管进行心肺转流的安全性和有效性。次要结局是评估术前危险因素作为经颈静脉插管的适应证。右颈总动脉和右颈内静脉插管，采用真空辅助静脉引流启动全心肺转流。在减压的心脏上进行再次胸骨切开术，并通过近红外光谱监测双侧额区局部脑氧饱和度。
共纳入 35 例患者。术后无死亡、神经或血管并发症发生。平均左侧和右侧近红外光谱分别为 70.0%（±10.5）和 64.2%（±12.0），平均差值为 5.7%（±6.9）。主要术前危险因素为：升主动脉粘连（45.7%）、移植物粘连（40%）、胸骨后右心室严重扩张（17.1%）和骨骼畸形（14.3%）。
在儿童和成人先天性心脏病高危再次胸骨切开术前进行右侧颈部血管插管进行外周心肺转流术是一种安全有效的策略。结合近红外光谱监测，可以确保足够的脑氧合，同时最大限度地降低灾难性出血的风险。
