Sustained Total All-region Perfusion During The Norwood Operation Is Associated With Improved Post-operative Recovery
James M. Meza, Abigal Benkert, MD, Neel Prahbu, BA, Veerajalandhar Allareddy, MBBS, Andrew McCrary, MD, Edmund Jooste, MbCHb, Nicholas Andersen, md, Joseph Turek, MD, PhD.
Duke University Medical Center, Durham, NC, USA.
Objective(s): We recently developed a technique for Norwood reconstruction with continuous perfusion of the head, heart, and lower body at mild hypothermia [Sustained Total All-Region (STAR) perfusion]. We hypothesized that STAR perfusion would shorten cardiopulmonary bypass and procedural times and expedite post-operative recovery.
Methods: Between 2012-2019, 51 infants underwent primary Norwood reconstruction at our institution. Outcomes for Norwood reconstruction using STAR perfusion (n=21) were compared to those with conventional cerebral perfusion only (n=30). STAR perfusion was performed with innominate artery cannulation as well as olive tip cannulas inserted into the opened descending aorta and native aortic root, to continuously perfuse the head, heart, and lower body throughout the procedure (Figure), under mild hypothermia (32-34°C).
Results: STAR perfusion was associated with shorter median CPB times vs. conventional perfusion (161 vs. 226 minutes, p <0.0001) and of myocardial ischemia (0 vs. 90 minutes cross-clamp time, p <0,0001). Total operative time was reduced by over 3 hours (319 vs 514 minutes, p<0.0001]. During post-operative recovery, those with STAR perfusion more rapidly normalized of serum lactate (19.3 vs. 26.5 hours, p=0.0009), had lower peak serum lactate levels (8.6 vs.10 mmol/dL, p=0.04) and fewer days until chest closure (3 vs. 5 days, p=0.04). Survival to hospital discharge (95% vs 83%, p=0.38) was similar.
Conclusions: STAR perfusion is a safe technique that eliminates ischemic time to the heart and lower body and allows for the procedure to be performed at warmer temperatures. Improvements in operative time, hemostasis, end-organ function, and post-operative recovery with noted as well.
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