Beating heart thoracic aortic surgery under selective myocardial perfusion for patients with congenital aortic anomalies
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ORIGINAL ARTICLE
Beating heart thoracic aortic surgery under selective myocardial perfusion for patients with congenital aortic anomalies Tai Fuchigami1 · Masahiko Nishioka1 · Yutaka Tamashiro2 · Nobuhiro Nagata1 Received: 31 October 2019 / Accepted: 24 January 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective We evaluated beating heart thoracic aortic surgery (BHTAS) using selective myocardial perfusion (SMP) in patients with aortic anomalies with complex surgical needs. Methods Between 2012 and 2018, 27 infants with aortic anomalies underwent BHTAS using SMP. Results Median body weight was 3.5 kg (range 2.6–5.2). In total, 15 cases of aortic coarctation, 7 cases of hypoplastic left heart syndrome, and 5 cases of interrupted aortic arch were included. An extended aortic arch anastomosis maneuver was used in 7 cases and aortic arch reconstruction compensated with an autologous pericardium patch was used in 6 cases. A Norwood-type procedure was used in 11 cases. The median Aristotle comprehensive score was 13.9 (7.0–20.0). BHTAS cases were not inferior in postoperative CK-MB/CK ratio (12.4 ± 2.8 in BHTAS vs 13.9 ± 3.6 in CTAS, p = 0.09), and there were no instances of myocardial ischemia. Two late deaths occurred due to shunt obstruction (n = 1) and valve malfunction (n = 1). Freedom from aortic reintervention was not inferior to conventional thoracic aortic surgery. BHTAS cases exhibited shorter cardiac arrest time than that of conventional thoracic aortic surgery in similar surgical procedures [CoA/VSD cases: 48.0 ± 8.0 min in the BHTAS cases and 65.7 ± 10.8 min in the CTAS cases (p = 0.0122), simple CoA/re-CoA cases: 0 min in the BHTAS cases and 20.1 ± 3.6 min in the CTAS cases]. Conclusions BHTAS reduced cardioplegic arrest time while maintaining postoperative CK-MB/CK ratio, mid-term death, and aortic reintervention rates. Keywords Beating heart · Selective perfusion · Infant · Aortic coarctation · Hypoplastic left heart syndrome
Introduction Congenital aortic or aortic arch anomalies generally require surgical repair during the neonatal period or early infancy. At times, complicated procedures are necessary for treating patients with thoracic aortic anomalies and/or intracardiac Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01304-7) contains supplementary material, which is available to authorized users. * Tai Fuchigami [email protected] 1
Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Arakawa 118‑1, Haebaru‑cho, Okinawa 901‑1193, Japan
Department of Clinical Engineering, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Arakawa 118‑1, Haebaru‑cho, Okinawa 901‑1193, Japan
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anomalies. Use of Norwood-type procedures or aortic arch repair of a beating heart was first reported more than a decade ago [1, 2]. For some complex cases, we began to perform beating heart thoracic aortic surgery (BHTAS) using sel
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