Christo I. Tchervenkov, MD, Stephen J

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Presentation transcript:

Neonatal aortic arch reconstruction avoiding circulatory arrest and direct arch vessel cannulation Christo I. Tchervenkov, MD, Stephen J. Korkola, MD, Dominique Shum-Tim, MD, Christos Calaritis, BS, Eric Laliberté, Teodoro U. Reyes, MD, Josée Lavoie, MD The Annals of Thoracic Surgery Volume 72, Issue 5, Pages 1615-1620 (November 2001) DOI: 10.1016/S0003-4975(01)03063-6

Fig 1 Technique 1. The right side of the ascending aorta is cannulated 5 mm proximal to the innominate artery. Under deep hypothermia, the arterial cannula is advanced into the innominate artery and snared in place. A clamp is placed on the descending thoracic aorta and the left subclavian and carotid arteries are snared while continuous low-flow cerebral perfusion is maintained through the innominate artery. Arch reconstruction is carried out using pulmonary homograft patch aortoplasty. The Annals of Thoracic Surgery 2001 72, 1615-1620DOI: (10.1016/S0003-4975(01)03063-6)

Fig 2 Technique 2. A modified Blalock–Taussig shunt is fully constructed before cannulation for cardiopulmonary bypass. The arterial cannula is advanced into the pulmonary artery confluence through the patent ductus arteriosus and low-flow cerebral perfusion is maintained by retrograde flow through the shunt into the innominate artery, with the branch pulmonary arteries snared. Snares on the arch vessels and a clamp on the descending thoracic aorta, allow reconstruction of the aortic arch, ascending aorta, and proximal pulmonary artery with a pulmonary homograft patch. The Annals of Thoracic Surgery 2001 72, 1615-1620DOI: (10.1016/S0003-4975(01)03063-6)

Fig 3 Technique 3. The distal aortic arch is isolated by applying a clamp just distal to the innominate artery, a second clamp to the descending thoracic aorta, and snaring of the left carotid and left subclavian arteries. While cerebral perfusion is maintained through the ascending aorta into the innominate artery, the aortic arch is reconstructed. The Annals of Thoracic Surgery 2001 72, 1615-1620DOI: (10.1016/S0003-4975(01)03063-6)