Innovations On The Norwood Procedure: Sustained Total All-Region (STAR) Perfusion
Neel K. Prabhu, BSE, James M. Meza, MD, MSc, Joseph Nellis, MD, Nicholas D. Andersen, MD, Joseph W. Turek, MD, PhD, MBA.
Duke University Medical Center, Durham, NC, USA.
Objective(s): Recovery following the neonatal Norwood procedure is often complicated by bleeding, acute kidney injury, systemic inflammatory response, and low cardiac function. The traditional conduct of this operation under deep hypothermic circulatory arrest likely exacerbates these problems. Total body perfusion during Norwood reconstruction may improve post-operative recovery by cooling to only mild hypothermia and eliminating ischemic time in all vascular beds. Here, we present a novel technique for sustained total all-region (STAR) perfusion of the heart, upper body, and lower body throughout the Norwood operation.
Methods: Using live video from the operating room as well as detailed illustrations, we describe the conduct of a Norwood procedure utilizing STAR perfusion. Throughout the video, we describe our intraoperative decision making during critical steps.
Results: This video captures the conduct of a Norwood operation where STAR perfusion was successfully utilized. The operation was performed at mild hypothermia (34 C) and there was no evidence of intra-operative myocardial ischemia as assessed by continuous EKG monitoring and visualization of the beating heart. Surgical exposure was excellent and not hindered by the perfusion cannulas. Since development of the STAR technique, 37 patients at our institution have undergone the operation with 97% survival to hospital discharge.
Conclusions: STAR perfusion allows for total body perfusion during the entire Norwood operation at mild hypothermia. However, formal investigation into long-term outcomes associated with this technique is warranted.
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