Neonatal aortic arch reconstruction avoiding circulatory arrest and directarch vessel cannulation

Background. Aortic arch reconstruction in neonates routinely requires deep hypothermic circulatory arrest. We reviewed our experience with techniques of continuous low-flow cerebral perfusion (LFCP) avoiding direct arch vesse l cannulation. Methods. Eighteen patients, with a median age of 11 days (range 1 to 85 day s) and a mean weight of 3.2 +/- 0.8 kg, underwent aortic arch reconstructio n with LFCP. Seven had biventricular repairs with arch reconstruction, 9 un derwent the Norwood operation and 2 had isolated arch repairs. In 1 Norwood and 7 biventricular repair patients, LFCP was maintained by advancing the cannula from the distal ascending aorta into the innominate artery. In 8 of 9 Norwood patients, LFCP was maintained by directing the arterial cannula into the pulmonary artery confluence and perfusing the innominate artery th rough the right modified Blalock-Taussig shunt fully constructed before can nulation for cardiopulmonary bypass. In 2 patients requiring isolated arch reconstruction, the ascending aorta was cannulated and the cross-clamp was applied just distal to the innominate artery. Results. LFCP was maintained at 0.6 +/- 0.2 L (.) min(-1) m(-2) for 41.0 +/ - 13.9 minutes at 18.5 degreesC +/- 1.1 degreesC. In 10 of the 18 patients, blood pressure during LFCP was 15 +/- 8 mm Hg remote from the innominate a rtery (left radial, umbilical or femoral arteries). In 8 of the 18 patients , right radial pressure during LFCP was 24 +/- 10 mm Hg. The mean mixed-ven ous saturation was 79.8% +/- 10% during LFCP. Two patients had preoperative seizures, whereas none had seizures postoperatively. One patient died. Conclusions. Neonatal aortic arch reconstruction is possible without circul atory arrest or direct arch vessel cannulation. These techniques maintained adequate mixed-venous oxygen saturations with no associated adverse neurol ogic outcomes. (C) 2001 by The Society of Thoracic Surgeons.