초록접수 현황
| 15F-218 | 구연 발표 |
A New Innominate Artery Cannulation Technique for Selective Regional Cerebral Perfusion in Aortic Arch Surgery in Infants
김형태¹, 성시찬¹, 최광호¹, 이형두², 반길호², 김지나²
부산대학교 의과대학 양산부산대학교병원 흉부외과학교실¹, 부산대학교 의과대학 양산부산대학교병원 소아과학교실²
Background : A selective regional cerebral perfusion (SRCP) has been widely adopted for the brain protection in neonatal or infant aortic arch surgeries. The anastomosis of the small polytetrafluoroethylene (PTFE) tube graft to the innominate artery has been used for the SRCP in many institutions. We developed a new technique of the innominate artery cannulation for the SRCP to reduce innominate artery clamping time and intraoperative needle hole bleeding.
Methods : Since January 2015, aortic arch repairs using a new arterial cannulation technique have been performed in a total of 18 consecutive neonatal or infant patients. Among them, we were able to get the line pressure data during cardiopulmonary bypass (CPB) in 13 patients (8 males and 5 females). The median age and weight at the operation were 7 days (1-55) and 3.12 kg (2.57-4.20), respectively. The diagnoses were coarctation of aorta (CoA) with ventricular septal defect in 6, CoA with atrial septal defect in 3, hypoplastic left heart syndrome in 3, and CoA with mitral stenosis and aortic stenosis (Shone complex) in 1 patient. We made a purse-string suture in the innominate artery above the innominate vein, and cannulated the metal tip of the metal-tipped PTFE tube graft (3.5mm) at the purse-string suture site after clamping of the innominate artery. The PTFE tube graft was then connected to the 10Fr DLP arterial cannula.
Results : There was no bleeding in the arterial cannulation site during the operation in all cases. Mean CPB time was 126.6±35.2 min (79-193), and mean SRCP time was 33.0±6.2 min (23-44). During full flow CPB (180 mL/min/kg), the mean blood pressure and line pressure were 41.2±7.3 mmHg (29-55) and 134.5±22.6 mmHg (105-180), respectively. There was no cannulation site stenosis or aneurysmal dilatation in postoperative computed tomography angiography in all patients. No neurologic dysfunction was noted after the operation.
Conclusion : The present study shows that a new innominate artery cannulation technique using a newly developed arterial cannula tip is a safe and simple method in aortic arch surgeries in infants.
Methods : Since January 2015, aortic arch repairs using a new arterial cannulation technique have been performed in a total of 18 consecutive neonatal or infant patients. Among them, we were able to get the line pressure data during cardiopulmonary bypass (CPB) in 13 patients (8 males and 5 females). The median age and weight at the operation were 7 days (1-55) and 3.12 kg (2.57-4.20), respectively. The diagnoses were coarctation of aorta (CoA) with ventricular septal defect in 6, CoA with atrial septal defect in 3, hypoplastic left heart syndrome in 3, and CoA with mitral stenosis and aortic stenosis (Shone complex) in 1 patient. We made a purse-string suture in the innominate artery above the innominate vein, and cannulated the metal tip of the metal-tipped PTFE tube graft (3.5mm) at the purse-string suture site after clamping of the innominate artery. The PTFE tube graft was then connected to the 10Fr DLP arterial cannula.
Results : There was no bleeding in the arterial cannulation site during the operation in all cases. Mean CPB time was 126.6±35.2 min (79-193), and mean SRCP time was 33.0±6.2 min (23-44). During full flow CPB (180 mL/min/kg), the mean blood pressure and line pressure were 41.2±7.3 mmHg (29-55) and 134.5±22.6 mmHg (105-180), respectively. There was no cannulation site stenosis or aneurysmal dilatation in postoperative computed tomography angiography in all patients. No neurologic dysfunction was noted after the operation.
Conclusion : The present study shows that a new innominate artery cannulation technique using a newly developed arterial cannula tip is a safe and simple method in aortic arch surgeries in infants.
책임저자: 성시찬
부산대학교 의과대학 양산부산대학교병원 흉부외과학교실
연락처 : 김형태, Tel: 055-360-2127 , E-mail : 2719k@naver.com
