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Eur J Cardiothorac Surg 2001;19:708-710
© 2001 Elsevier Science NL

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Surgical technique to avoid circulatory arrest and direct arch vessel cannulation during neonatal aortic arch reconstruction

The Division of Cardiovascular Surgery, The Montréal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada

Received 12 October 2000; received in revised form 7 February 2001; accepted 28 February 2001.

Corresponding author. Tel.: +1-514-934-4400, ext. 2394; fax: +1-514-934-4330
e-mail: christo.tchervenkov{at}muhc.mcgill.ca

Deep hypothermic circulatory arrest (DHCA) has been used routinely for surgery involving the aortic arch. Recently, techniques have been developed that avoid circulatory arrest and maintain low-flow cerebral perfusion (LFCP) in an attempt to avoid the potential neurological sequelae associated with DHCA. We describe a technique of LFCP that avoids circulatory arrest and direct cannulation of the arch vessels. Five patients underwent reconstruction of the aortic arch with concomitant biventricular intracardiac repair. The distal ascending aorta was cannulated and patients were systemically cooled. The cannula was advanced into the innominate artery and snared in place prior to opening and reconstructing the aorta with continuous LFCP. In all five patients, we completely avoided circulatory arrest and direct cannulation of the arch vessels. All patients survived and there were no adverse neurological outcomes.

Key Words: Aortic arch reconstruction • Circulatory arrest • Continuous low-flow cerebral perfusion

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