Technique for the Norwood Procedure Using Normothermic Selective Cerebral Perfusion

Abstract

The Norwood procedure is commonly performed using either circulatory arrest or deep hypothermia with low-flow cardiopulmonary bypass. We describe our technique for the Norwood procedure using selective cerebral perfusion with corporeal normothermia (> 32 degrees C). A right radial artery catheter was placed and cerebral NIRS applied. A C-clamp was placed upon the innominate artery and gortex shunt placed. Cardiopulmonary bypass was established through the shunt. A 7.0 purse-string was placed at the beginning of the arch and a cross-clamp applied superior to this and cold cardioplegia was given by hand. The left carotid and subclavian were snared and a C-clamp was placed on the distal descending aorta. The cross-clamp was then repositioned across the base of the innominate and pump flow was reduced. This resulted in arch isolation with a bloodless field. Perfusion was then transferred to a neo-artic cannula and the central shunt completed. Cardiopulmonary bypass time was approximately 60 minutes and cardiac arrest time was approximately 20 minutes; core temperature had not dropped below 32 degrees C. The Norwood procedure can be successfully performed with normothermic selective cerebral perfusion thereby offering the theoretical benefit of avoiding deep hypothermia with or without circulatory arrest.