The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 4 , Pages 803-806 , April 2009

The quest to optimize neurodevelopmental outcomes in neonatal arch reconstruction: The perfusion techniques we use and why we believe in them

  • Richard G. Ohye, MD

      Affiliations

    • Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
    • Corresponding Author InformationAddress for reprints: Richard G. Ohye, MD, 5144 CVC/SPC 5864, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5864.
    • ,
  • Caren S. Goldberg, MD, MS

      Affiliations

    • Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Janet Donohue, MPH, MS

      Affiliations

    • Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Jennifer C. Hirsch, MD, MS

      Affiliations

    • Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Michael Gaies, MD

      Affiliations

    • Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Marshall L. Jacobs, MD

      Affiliations

    • Department of Cardiothoracic Surgery, Drexel University, College of Medicine, Philadelphia, Pennsylvania
    • ,
  • James G. Gurney, PhD

      Affiliations

    • Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Michigan
    • ,
  • Michigan Congenital Heart Outcomes Research and Discovery Investigators

Received 8 October 2008 ,Accepted 31 October 2008.

References 

  1. Mahle WT, Spray TL, Wernovsky G, Gaynor JW, Clark BJ. . Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15 year experience from a single institution. Circulation. 2000;102(19 suppl. 3):III136–III141
  2. Bove EL, Lloyd TR. Staged reconstruction for hypoplastic left heart syndrome. Contemporary results. Ann Surg. 1996;224:387–394
  3. Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, et al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation. 2002;106(suppl I):I82–I89
  4. Kern JH, Hayes JH, Michler RE, Gersony WM, Quagebeur JM. Survival and risk factor analysis for the Norwood procedure for hypoplastic left heart syndrome. Am J Cardiol. 1997;80:170–174
  5. Oates RK, Simpson JM, Turnbull JAB, Cartmill TB. The relationship between intelligence and duration of circulatory arrest with deep hypothermia. J Thorac Cardiovasc Surg. 1995;110:786–792
  6. Newburger JW, Jonas RA, Wernovsky G, Wypij D, Hickey PR, Kuban KC, et al. A comparison of perioperative neurologic effects of hypothermic circulatory arrest versus low flow cardiopulmonary bypass in infant heart surgery. N Engl J Med. 1993;329:1057–1064
  7. Bellinger DC, Wypij D, Kuban KC, Rappaport LA, Hickey PR, Wernovsky G, et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation. 1999;100:526–532
  8. Asou T, Kado H, Imoto Y, Shiokawa Y, Tominaga R, Kawachi Y, et al. Selective cerebral perfusion technique during aortic arch repair in neonates. Ann Thorac Surg. 1996;61:1546–1548
  9. Pigula FA, Nemoto EM, Griffith BP, Siewers RD. Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg. 2000;119:331–339
  10. Tchervenkov CI, Chu VF, Shum-Tim D, Laliberte E, Reyes TU. Norwood operation without circulatory arrest: a new surgical technique. Ann Thorac Surg. 2000;70:1730–1733
  11. Myung RJ, Petko M, Judkins AR, Schears G, Ittenbach RF, Waibel RJ, et al. Regional low-flow perfusion improves neurologic outcome compared with deep hypothermic circulatory arrest in neonatal piglets. J Thorac Cardiovasc Surg. 2004;127:1051–1057
  12. Goldberg CS, Bove EL, Devaney EJ, Mollen E, Schwartz E, Tindall S, et al. A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: outcomes for infants with functional single ventricle. J Thorac Cardiovasc Surg. 2007;133:880–887
  13. Dent CL, Spaeth JP, Jones BV, Schwartz SM, Glauser TA, Hallinan B, et al. Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion. J Thorac Cardiovasc Surg. 2006;131:190–197
  14. Visconti KJ, Rimmer D, Gauvreau K, del Nido P, Mayer JE, Hagino I, et al. Regional low-flow perfusion versus circulatory arrest in neonates: one-year neurodevelopmental outcome. Ann Thorac Surg. 2006;82:2207–2213
  15. Langley SM, Chai PJ, Miller SE, Mault JR, Jaggers JJ, Tsui SS, et al. Intermittent perfusion protects the brain during deep hypothermic circulatory arrest. Ann Thorac Surg. 1999;68:4–12
  16. Jadad AR, Moore RA, Carroll D. Assessing the quality of randomized controlled clincal trials: is blinding necessary?. Control Clin Trials. 1996;17:1–12
  17. Gaynor JW, Wernovsky G, Jarvik GP, Bernbaum J, Gerdes M, Zackai E, et al. Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery. J Thorac Cardiovasc Surg. 2007;133:1344–1353
  18. Jonas RA, Wypij D, Roth SJ, Bellinger DC, Visconti KJ, du Plessis AJ, et al. The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants. J Thorac Cardiovasc Surg. 2003;126:1765–1774
  19. Wypij D, Jonas RA, Bellinger DC, Del Nido PJ, Mayer JE, Bacha EA, et al. The effect of hematocrit during hypothermic cardiopulmonary bypass in infant heart surgery: results from the combined Boston hematocrit trials. J Thorac Cardiovasc Surg. 2008;135:355–360

 The Michigan Congenital Heart Outcomes Research and Discovery Program is supported by a grants from the Department of Surgery and the Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Michigan.

PII: S0022-5223(08)01942-9

doi: 10.1016/j.jtcvs.2008.10.046

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 4 , Pages 803-806 , April 2009

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