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Thorac Cardiovasc Surg 2012; 60(03): 189-194
DOI: 10.1055/s-0030-1271042
Original Cardiovascular
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Aortic Arch Repair: Let It Beat!

A. Rüffer
1   Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
,
C. Klopsch
2   Department of Cardiac Surgery, Medical Faculty, University of Rostock, Rostock, Germany
,
F. Münch
1   Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
,
U. Gottschalk
3   Department of Pediatric Cardiology, University-Heart-Center-Hamburg, Hamburg, Germany
,
T. S. Mir
3   Department of Pediatric Cardiology, University-Heart-Center-Hamburg, Hamburg, Germany
,
J. Weil
3   Department of Pediatric Cardiology, University-Heart-Center-Hamburg, Hamburg, Germany
,
H. C. Reichenspurner
4   Department of Cardiovascular Surgery, University-Heart-Center-Hamburg, Hamburg, Germany
,
R. A. Cesnjevar
1   Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

15 December 2010

18 March 2011

Publication Date:
28 April 2011 (online)

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Abstract

Objective Aortic arch repair (AAR) on the beating heart may reduce cross-clamping times and offer improved postoperative cardiac function.

Methods A single-center review of all patients (n = 24) who underwent surgical AAR during biventricular repair between 01/2006 and 01/2008 was done. All patients were operated on under cardiopulmonary bypass (CPB) with antegrade cerebral perfusion (ACP). During AAR, 13 patients (group 1) received cardioplegic arrest, and were compared to 11 patients (group 2) who underwent a beating-heart modification with selective myocardial perfusion. Seventeen patients had additional intracardiac lesions and underwent simultaneous correction during the procedure.

Results Durations of CPB, AAR and ACP did not differ statistically between groups. Cardioplegic arrest time was significantly lower in group 1 (34 ±  13 vs. 76 ±  11 min, p = 0.02) and resulted in a subsequent reduction of myocardial ischemic damage as borne out by lower postoperative levels of troponin T and CK-MB (2.5 ±  0.7 vs. 7.1 ±  1.4 ng/mL, p = 0.02; 68.7 ±  11.5 vs. 149.1 ±  27.2 U/l, p = 0.03). We observed an enhanced patient recovery with shorter inotropic and ventilatory support times (p < 0.05).

Conclusion Pediatric aortic arch correction on a CPB beating heart with selective myocardial perfusion is technically feasible and safe. The reduction of the myocardial ischemic time is effective and results in less myocardial damage.

Keywords

aorta/aortic - cardiopulmonary bypass, CPB - congenital heart disease, CHD
 

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