Heart transplantation for hypoplastic left heart syndrome: Modified technique for reducing circulatory arrest time

Background: The surgical technique of heart transplantation as therapy in i nfants with hypoplastic left heart syndrome was first reported over a decad e ago. Since that time, incremental refinements have evolved that both faci litate the operation and potentially reduce the perceived neurologic hazard s associated with the use of hypothermic circulatory arrest. Methods: Minor technical adjustments have permitted infant heart transplant ation to be accomplished with relative ease while markedly limiting the nee d for complete circulatory arrest. Low-flow hypothermic systemic perfusion is used for atrial implantation, reserving circulatory arrest for arch reco nstruction only. This is accomplished by use of an active (pump) sucker for venous return. Result: Mean circulatory arrest time with the current technique has been 26 minutes. Conclusion: Minor technical refinements have resulted in a marked reduction in hypothermic circulatory arrest time during infant heart transplantation for hypoplastic left heart syndrome.