American Association of Plastic Surgeons

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How I repair Neonatal Total Anomalous Pulmonary Venous Connection (TAPVC) using Mild Hypothermic (32c) Full Flow CPB
richard gates, MD, JoAnne Starr, MD.
CHOC Children's, orange, CA, USA.

How I repair Neonatal Total Anomalous Pulmonary Venous Connection (TAPVC) using Mild Hypothermic (32c) Full Flow CPB
Objectives: Repair of TAPVC in neonates is frequently carried out with deep hypothermia with or without circulatory arrest. Deep hypothermia is associated with a profound physiologic response as well as adverse neurodevelopmental outcomes. To ameliorate this adverse response we developed a technique to repair TAPVC using continuous mild hypothermic Full Flow cardiopulmonary bypass (cMHCB).
Technique/Methods: Bicaval cannulation is used. The ductus is ligated after initiation of CPB and single dose Del Nido cardioplegia delivered. The heart is freed posteriorly and the pulmonary veins dissected free and surrounded. The vertical vein is either ligated or divided. Neuro-clips are placed on the veins and the confluence opened. With the cava not snared the back of the left atrium is opened and the anastomosis created. Once completed the cava are snared and the right atrium opened and the ASD now patched. The neuro-clips are now remove and the procedure completed.
Results/Conclusion: A retrospective review of all neonatal patients undergoing repair of TAPVC utilizing cMHCB at our institution from 2003-2018 was performed. There were 56 neonatal TAPVC patients who underwent surgery utilizing cMHCB: supracardiac (n=27), cardiac (n=11), infracardiac (n=17) and mixed (n=1). Twenty patients had preoperative obstruction (35.7%). There were 2 early (3.4 %) deaths. Recurrent obstruction requiring reintervention occurred in 1 (1.8%).


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