Abstract
IntroductionSimplified Aortic Cannulation (SAC), wherein the innominate artery is used as the arterial inflow site rather than the ascending aorta, has proved to be a useful technique for arterial cannulation especially for small neonates undergoing complex cardiac operations. Since few technical options are available for re-entry cardiac injuries in small infants, we postulate that this technique may be equally helpful in those situations.Case PresentationWe employed SAC in 4 infants undergoing reoperative cardiac surgery (prior Norwood, n = 2; prior arterial switch operation with suprasystemic pulmonary artery pressures after a Le Compte maneuver, n = 1; prior Ebstein's anomaly, n = 1). In all cases the innominate artery was exposed at the level of the supra-sternal notch, and a 3.5 mm expanded polytetrafluoroethylene (ePTFE) graft was anastomosed to the innominate artery (n = 3), and a 10 French cannula inserted into the graft for whole-body perfusion. Right atrial cannulation was obtained by dividing the anterior aspect of the diaphragm at the level of the xiphisternum, gaining easy access to the right atrial-inferior vena cava junction, without separating the sternal edges.Discussion and EvaluationAll four infants successfully underwent their operations using SAC. In one case (2nd stage palliation for hypoplastic left heart syndrome) a cardiac injury occurred upon sternal reentry, but utilizing SAC, this was repaired without consequence.ConclusionSimplified aortic cannulation and direct right atrial cannulation may be obtained without dividing the sternum in complex reoperative infant surgeries, without making additional incisions. This may be life-saving in reoperative cardiac injuries in small infants.
Highlights
Simplified Aortic Cannulation (SAC), wherein the innominate artery is used as the arterial inflow site rather than the ascending aorta, has proved to be a useful technique for arterial cannulation especially for small neonates undergoing complex cardiac operations
Simplified aortic cannulation and direct right atrial cannulation may be obtained without dividing the sternum in complex reoperative infant surgeries, without making additional incisions. This may be life-saving in reoperative cardiac injuries in small infants
Simplified Aortic Cannulation (SAC), wherein the innominate artery is used as the arterial inflow site rather than the ascending aorta, has made a significant impact on the conduct of complex operations for congenital heart disease, such as the Sano-Norwood operation, and cardiac operations in very small neonates or those with diminutive ascending aortas. [1,2]
Summary
We use Simplified Aortic Cannulation routinely for complex congenital heart surgery, especially in very small neonates and those with small ascending aortas, or in whom the ascending aorta needs repair (e.g., aorto-pulmnoary window) It allows good arterial access in situations where the aorta is either too diminutive to accept a sufficiently sized cannula, or in cases where it is advantageous to avoid placing a cannula in the ascending aorta in close proximity to the area of reconstruction. We have expanded our utilization of SAC to include reoperative cases, where the risk of sternal reentry injuries is high, or in which inadvertent sternal reentry injuries have occurred requiring the initiation of CPB in infants not suitable for femoral cannulation We have found it to be an extremely helpful adjunct to the congenital heart surgeon in reoperative complex cardiac surgery. The technique may be used in older patients with equal ease, and may provide the congenital cardiac surgeon with a viable alternative strategy in the operating room
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