Abstract:
:Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro-myocardial protection was recently developed, where regional low-flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short-term and mid-term results of selective and independent cerebro-myocardial perfusion in neonatal aortic arch surgery. From April 2008 to August 2015, 28 consecutive neonates underwent aortic arch surgery under cerebro-myocardial perfusion. There were 17 male and 11 female, with median age of 15 days (3-30 days) and median body weight of 3 kg (1.6-4.2 kg), 9 (32%) of whom with low body weight (<2.5 kg). The spectrum of pathologies treated was heterogeneous and included 13 neonates having single-stage biventricular repair (46%), 7 staged biventricular repair (25%), and 8 single-ventricle repair (29%). All operations were performed under moderate hypothermia and with a "beating heart and brain." Average cardiopulmonary bypass time was 131 ± 64 min (42-310 min). A period of cardiac arrest to complete intra-cardiac repair was required in nine patients (32%), and circulatory arrest in 1 to repair total anomalous pulmonary venous connection. Average time of splanchnic ischemia during cerebro-myocardial perfusion was 30 ± 11 min (15-69 min). Renal dysfunction, requiring a period of peritoneal dialysis was observed in 10 (36%) patients, while liver dysfunction was noted only in 3 (11%). There were three (11%) early and two late deaths during a median follow-up of 2.9 years (range 6 months-7.7 years), with an actuarial survival of 82% at 7 years. At latest follow-up, no patient showed signs of cardiac or neurologic dysfunction. The present experience shows that a strategy of selective and independent cerebro-myocardial perfusion is safe, versatile, and feasible in high-risk neonates with complex congenital arch pathology. Encouraging outcomes were noted in terms of cardiac and neurological function, with limited end-organ morbidity.
journal_name
Artif Organsjournal_title
Artificial organsauthors
Hoxha S,Abbasciano RG,Sandrini C,Rossetti L,Menon T,Barozzi L,Linardi D,Rungatscher A,Faggian G,Luciani GBdoi
10.1111/aor.13128subject
Has Abstractpub_date
2018-04-01 00:00:00pages
457-463issue
4eissn
0160-564Xissn
1525-1594journal_volume
42pub_type
杂志文章abstract::Transcatheter aortic valve implantation (TAVI) has gained considerable acceptance in the past decade due to its lower risks than conventional open-heart surgery. However, the deformation and delamination of the leaflets during the crimping procedure have raised questions about the durability and long-term serviceabili...
journal_title:Artificial organs
pub_type: 杂志文章
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abstract::Contamination of a ventriculoatrial shunt (VAS) with skin organisms that are usually nonpathogenic may be followed by an immunologically mediated renal injury. The bacteria characteristically involved are coagulase-negative Staphylococci (e.g., Staphylococcus epidermidis), which strongly adhere to the plastic surface ...
journal_title:Artificial organs
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journal_title:Artificial organs
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更新日期:2019-10-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12682
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journal_title:Artificial organs
pub_type: 杂志文章
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1997.tb00451.x
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12390
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.13270
更新日期:2019-01-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.13631
更新日期:2020-06-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1988.tb02813.x
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1992.tb00537.x
更新日期:1992-08-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2004.07374.x
更新日期:2004-07-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章,多中心研究
doi:10.1111/aor.12912
更新日期:2017-09-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.13713
更新日期:2020-08-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2007.00408.x
更新日期:2007-06-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1993.tb00381.x
更新日期:1993-01-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1986.tb02541.x
更新日期:1986-06-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1987.tb02622.x
更新日期:1987-02-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1995.tb02362.x
更新日期:1995-05-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1983.tb04219.x
更新日期:1983-11-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12252
更新日期:2014-07-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.1979.tb03801.x
更新日期:1979-02-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12218
更新日期:2014-07-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.2003.07175.x
更新日期:2003-01-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/j.1525-1594.2009.00864.x
更新日期:2009-09-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1111/aor.12608
更新日期:2016-06-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.2002.06999.x
更新日期:2002-05-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.1999.06448.x
更新日期:1999-11-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章
doi:10.1046/j.1525-1594.2000.06506.x
更新日期:2000-04-01 00:00:00
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journal_title:Artificial organs
pub_type: 杂志文章,评审
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更新日期:2005-09-01 00:00:00