Continuous systemic perfusion improves outcome in one stage repair of obstructed aortic arch and associated cardiac malformation

Objective: To determine whether continuous systemic perfusion is of effecti ve use when establishing primary repair of the aortic obstruction and assoc iated cardiac malformations. Methods: Since 1991, 56 infants have undergone reconstruction of interrupted (in 28) or coarctated (in 28) aorta, concomi tantly with closure of ventricular septal defects in 37, and repair of othe r malformations in the remaining 19. Of these, total circulatory arrest (30 +/- 11 min) was employed in 23. In another 21 patients, perfusion was main tained for the carotid arteries with the descending aorta cross-clamped (31 +/- 15 min). The bodily organs were perfused throughout the operative proc edures by placing dual aortic cannulae in the remaining 12 patients. Result s: The postoperative courses were less eventful in the non-circulatory arre st group than other groups of patients undergoing total or partial circulat ory arrest, although these groups were operated in different time periods, and consequently, a general progress might be one reason for improvements i n the surgical outcomes. All patients undergoing no circulatory arrest surv ived the primary repair, could have the sternum primarily closed, and had n o episodes of cerebral bleeding. Prolonged tracheal intubation was needed j ust in one patient of this group. The amount of urine output during cardiop ulmonary bypass was significantly greater in the non-circulatory arrest gro up than in the others. The maximal concentrations of urinary beta -microglo bulin, serous creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were lower in this setting. Conclusions: Continuous systemic p erfusion was considered less invasive when concomitantly repairing the obst ructed aorta and intracardiac malformations. (C) 2001 Elsevier Science B.V. All rights reserved.