Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery Frank A Pigula, MD, Sanjiv K Gandhi, MD, Ralph D.

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Presentation transcript:

Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery Frank A Pigula, MD, Sanjiv K Gandhi, MD, Ralph D Siewers, MD, Peter J Davis, MD, Steven A Webber, MD, Edwin M Nemoto, PhD The Annals of Thoracic Surgery Volume 72, Issue 2, Pages 401-407 (August 2001) DOI: 10.1016/S0003-4975(01)02727-8

Fig 1 Quadriceps muscle near-infrared spectroscopy in neonate undergoing Norwood operation for hypoplastic left heart syndrome. With the initiation of cardiopulmonary bypass (CPB), there is an increase in quadriceps muscle oxygen saturation (RQrSO2) with a stable quadriceps muscle blood volume. During a brief period (6 minutes) of circulatory arrest (CIRC ARREST), there is a sharp decline in muscle saturations and blood volumes. Immediately after the initiation of regional low-flow perfusion (RLFP) (20 mL/min), there is an increase in muscle blood volumes that continues as RLFP rate increases to 30 and then 40 mL/min. After approximately 5 minutes, there is a corresponding increase in muscle saturations. With completion of the neo-aorta, RLFP is stopped momentarily to allow for central recannulation, and standard CPB is resumed. The Annals of Thoracic Surgery 2001 72, 401-407DOI: (10.1016/S0003-4975(01)02727-8)

Fig 2 Gastric tonometry for 11 patients undergoing arch repair with regional low-flow perfusion (RLFP) versus 3 patients undergoing cardiac repair during deep hypothermic circulatory arrest (CA). Data are presented as the difference between the arterial and gastric mucosal carbon dioxide tensions (pCO2), the Pco2 gap (arterial Pco2 − gastric Pco2). There were no significant differences before cardiopulmonary bypass (Pre-CPB), during cooling on bypass (Cooling), or after separation from bypass (Post-CPB). During rewarming, gastric mucosal Pco2 increased relative to arterial Pco2, thus creating a negative Pco2 gap, suggesting ischemia. Differences in the Pco2 gap between the two groups were significant only during rewarming (p = 0.03 by analysis of variance [ANOVA]). The Annals of Thoracic Surgery 2001 72, 401-407DOI: (10.1016/S0003-4975(01)02727-8)

Fig 3 Mean blood urea nitrogen (BUN) (A) and creatinine (B) levels of 15 neonates undergoing cardiac repair during regional low-flow perfusion preoperatively (preop) and on postoperative days (pod) 1, 2, and 3. The Annals of Thoracic Surgery 2001 72, 401-407DOI: (10.1016/S0003-4975(01)02727-8)