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One-stage total repair of aortic arch anomaly using regional perfusion

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Authors
Lim, Hong-Gook; Kim, Woong-Han; Jang, Woo-Sung; Lim, Cheong; Kwak, Jae Gun; Lee, Cheul; Hwang, Seong Wook
Issue Date
2006-11-28
Publisher
Elsevier
Citation
Eur J Cardiothorac Surg. 2007 Feb;31(2):242-8. Epub 2006 Nov 28.
Keywords
Aortic Arch Syndromes/*surgeryAortic Coarctation/surgeryBrain Diseases/prevention & controlCardiopulmonary BypassCerebrovascular CirculationFollow-Up StudiesHeart Arrest, Induced/methodsHeart Septal Defects, Ventricular/surgeryHumansInfantInfant, NewbornPerfusion/methodsPostoperative ComplicationsTreatment Outcome
Abstract
OBJECTIVE: Primary repair of aortic arch obstructions and associated cardiac anomalies is a surgical challenge in neonates and infants. Deep hypothermic circulatory arrest prolongs myocardial ischemia and might induce cerebral and myocardial dysfunction. METHODS: From March 2000 to December 2005, 69 neonates or infants with aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion in the presence of a nonworking beating heart using the dual perfusion technique on the innominate artery and aortic root. Preoperative diagnoses of arch anomaly comprised aortic coarctation (n=54) or an interrupted aortic arch (n=15). Combined anomalies were ventricular septal defect (n=52), anomalous origin of the right pulmonary artery from ascending aorta (n=3), hypoplastic left heart syndrome (n=2), truncus arteriosus (n=2), atrioventricular septal defect (n=2), double outlet right ventricle (n=1), total anomalous pulmonary venous return (n=1), partial anomalous pulmonary venous return (n=1), and aortic stenosis (n=1). RESULTS: The mean regional perfusion time was 27.8+/-9.8 min. There was no operative mortality. Postoperative low cardiac output was present in four patients (5.8%). A neurologic complication was noted in one patient (1.5%) who developed transient chorea, but recovered completely. During 32.8+/-17.5 months of follow-up, one late death (1.5%) occurred. There was neither reoperation associated with arch anomaly nor recoarctation except in one patient. One patient developed left main bronchial compression necessitating aortopexy. CONCLUSIONS: One-stage total arch repair using our regional perfusion technique is an excellent method that may minimize neurologic and myocardial complications without mortality. Our surgical strategy for arch anomaly has a low rate of residual and recurrent coarctation when performed in neonates and infants.
ISSN
1010-7940 (Print)
Language
English
URI
http://ejcts.ctsnetjournals.org/cgi/content/full/31/2/242

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17126555

http://hdl.handle.net/10371/13823
DOI
https://doi.org/10.1016/j.ejcts.2006.10.035
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College of Medicine/School of Medicine (의과대학/대학원)Thoracic Surgery (흉부외과학전공)Journal Papers (저널논문_흉부외과학전공)
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