Sliding Arch Aortoplasty with Continuous Coronary Perfusion for Aortic Arch Hypoplasia Beyond Infancy
Nicholas B. Cavanaugh, BS1, Jason W. Tcheng, MD2, Alyse M. Carlson, BS1, Jose E. Torres, MD3, Sarah E. Holgren, BS1, Joseph W. Turek, MD, PhD1.
1Division of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa CIty, IA, USA, 2Harrison HealthPartners, Bremerton, WA, USA, 3Yavapai Cardiac Surgery, P.C., Prescott, AZ, USA.
OBJECTIVE: To demonstrate an innovative technique for hypoplastic arch reconstruction in children beyond infancy.
METHODS: The operation was performed via a median sternotomy. A Gore-tex graft was sewn onto the innominate artery and used for selective antegrade flow, while the right atrium was cannulated for venous drainage. Control was obtained of the arch vessels. Once on bypass and cooled, an accessory perfusion line was used to provide coronary flow throughout the procedure via cannulation of the proximal ascending aorta with a small cardioplegia needle. The ascending sliding arch aortoplasty was then performed as previously described.
RESULTS: The patient tolerated the procedure well and with a good clinical outcome. There was no arch gradient postoperatively.
CONCLUSIONS: While there is no definitive data to show that continuous coronary perfusion significantly improves outcomes, there is theoretical benefit to operating without inducing cardioplegic arrest. Admittedly, for isolated arch repair, cardioplegic arrest time should be well-tolerated. However, knowledge of this beating-heart technique for sliding arch aortoplasty repair could save valuable arrest time when concomitant intracardiac procedures are required. The typically long ascending aorta in patients with coarctation and hypoplasia of the aorta not only lends itself to performing a sliding arch aortoplasty, but also allows sufficient space on the ascending aorta for maintaining continuous coronary perfusion without additional difficulty.