CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
42
AFRICA
with a beating heart and body temperature of 25°C. A short period
of cardioplegic arrest was used to insert the patch into the ascending
aorta. A homograft patch was used in all patients but two, in whom a
porcine extracellular matrix patch was preferred. Mean cross clamp
time in isolated arch repair was 21 min.
Results:
One patient experienced a cardiac arrest in the first postop-
erative day, he was resuscitated and sustained with the ECMO but died
on the fifth postoperative day. One patient who received pulmonary
artery banding required further increase in the banding. None experi-
enced neurological damage or new onset of seizures. None required
further arch surgery after 38.6 months follow up (1–87 months).
Conclusions:
BCT cannulation in neonates allows us to perform arch
surgery under cardio-cerebral perfusion, thus reducing the cross-
clamp time. The results of our series are encouraging and evidence
that this technique is safe and effective.
1132: TELEMETRIC FLOWATCH PULMONARY ARTERY
BANDING:
SINGLE-CENTRE
EXPERIENCE AND
OUTCOMES
Abbas Khushnood, Arjamand Shauq, Matthew Christopherson,
Gordon Gladman, Ian Peart, Prem Venugopal, Ram Dhannapuneni,
Ed Ladusans
Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
Background:
An assumed advantage of the FloWatch pulmonary
artery band (PAB) is that it has a low incidence of pulmonary
artery (PA) distortion and requirement for PA reconstruction after
its removal. We describe our experience with FloWatch PAB with
regard to pulmonary artery distortion needing patch reconstruction
and admission stay in a large single-centre population.
Methods:
We carried out nearly 10 years of retrospective analysis
of all patients at our centre who underwent FloWatch PA banding to
control pulmonary blood flow for initial single-ventricle or bi-ventri-
cle palliation. In a total of 70 patients, the diagnosis was multiple
VSDs in 30, complete AVSD in 10, and 30 with mixed complex
congenital conditions.
Results:
Seventy patients needed FloWatch PAB between December
2003 and June 2012; 19/70 (27%) had single-ventricle morphology
and 51/70 (73%) biventricular morphology. Median age at the time
of PAB was 88 (range 7–1 486) days and median weight was 4.2
(range 2.6–15.9) kg. There were seven deaths in our series, six were
late deaths and were not associated with PA band. There was one
early death; 34/70 (48%) had their band removed for the next stage of
surgery and 36/70 (52%) still have the band in place; 23/34 (67%) did
not have any PA distortion and did not require any patch enlargement.
However, 11/34 (32%) had PA distortion needing patch enlargement.
Of more concern, in two/34 (6%) patients the FloWatch was found
to have eroded through the MPA at the time of its removal. The
mean duration of PICU stay after PAB insertion was 5.8 days; 46%
of patients were discharged within three days and 76% discharged
within seven days.
Conclusion:
Telemetric FloWatch PA banding does have undoubted
advantages over conventional banding in terms of adjustability of
pulmonary flow without re-operation and limited hospital stay. The
majority of patients did not require any patch reconstruction of the
pulmonary artery.
1149: ROOT REPLACEMENT WITH AORTIC VALVE SPAR-
ING IN PAEDIATRIC PATIENTS
Nestor Sandoval, Carlos Obando, Marisol Carreno, Juan Umana
Fundacion Cardioinfantil, Columbia
Background:
Aortic root and ascending aortic aneurysm in children
is a rare entity usually associated with connective tissue disorders.
Aortic valve sparing with ascending aortic replacement (TD) is the
ideal treatment in these patients
Objective:
To evaluate the short- and medium-term results of valve-
sparing aortic root replacement in paediatric patients.
Methods:
This was an historic cohort between January 2006 and
June 2010 and included patients under 15 years of age treated with
aortic valve re-implantation for aneurysm or dissection. Postoperative
clinical and echocardiographic follow up was performed.
Results:
Four patients with annulo-aortic ectasia had Marfan
syndrome and one had a type A dissection. Mean age was 10 years
(7–14); 75% were male in functional class I (50%) and II (50%).
There were no bicuspid valves. Two patients had aortic regurgitation
1+, and two had 3 to 4+. Aortic annulus was 23.7 mm (18–30), aortic
root was 60.7 mm (40–90), three patients received TD IV (75%),
one (25%) TD V. Aortic graft diameter was 28 mm (18–30); the TD
V was done with 30/22-mm tubes. Complications: three patients
presented with coagulopathy without re-operation for bleeding.
Echocardiogram showed in two patients, residual 1+ regurgitation. At
the end of follow up, there was no progression of aortic regurgitation,
and function and ventricular dimensions were preserved. All patients
are in functional class I and there were no re-operations or mortality.
Conclusions:
Aortic root replacement with valve sparing is useful in
the management of aortic root aneurysms and dissection in children,
preserving ventricular geometry and function, with low postopera-
tive morbidity and it eliminates the risk of chronic anticoagulation.
Studies of long-term monitoring will allow statistical power to evalu-
ate the durability of the anatomical and functional results.
1160: EXTENDED THORACIC AORTA REPAIR IN CHIL-
DREN VIA LEFT THORACOTOMY WITH DEEP HYPO-
THERMIC CIRCULATORY ARREST AND CERVICAL
CANNULATION
Attilio Lotto, Giuseppe Pelella, Paolo De Siena, Giles Peek
East Midlands Congenital Heart Centre, Glenfield Hospital,
Leicester, UK
Background:
Repair of the thoracic aorta via median sternotomy can
be difficult due to the limited exposure, particularly in older patients
or during re-do surgery. We are reporting a novel approach via left
thoracotomy with cervical cannulation for CPB.
Methods:
The patient is positioned supine and both RCCA and
RIJV are cannulated as per V-A ECMO. CPB is commenced and the
patient positioned to perform a left thoracotomy. The pericardium
is opened and a vent inserted in the LA appendix. The aortic arch,
head and neck vessels and the descending aorta are dissected while
cooling systemically. At temperature, the circulation is arrested, the
aorta cross clamped between the innominate and LCCA, the head and
neck vessels occluded, and cardioplegia is delivered into the ascend-
ing aorta through the arterial cannula. Antegrade cerebral perfusion
is commenced directly in the LCCA or via the arterial cannula
clamping between the LCCA and the LSA. The repair is performed
with extensive patch enlargement of the diseased aorta, after which
systemic circulation is restarted and the patient is rewarmed, weaned
off CPB and protamine is given. The thoracotomy is closed and the
patient is repositioned supine for neck decannulation with primary
vessel reconstruction.
Results:
Between June 2011 and August 2012, three patients were
operated. Median age and weight were, respectively, 14 months and
9.7 kg. Two patients had previous aortic surgery and presented with
severe hypoplastic distal aortic arch and recoarctation, one of whom
also had long descending aortic hypoplasia. The third patient had
severe aortic coarctation with a long hypoplastic descending aorta.
Perfusion times: (median): CPB
=
209 min; aortic cross-clamp
=
39
min; antegrade cerebral perfusion
=
25 min; peripheral body ischae-
mia
=
39 min, mean DHCA
=
20 min. Ther was no hospital mortality.
Postoperative echocardiography showed laminar flow in the descend-
ing aorta. No neurological symptoms were detected at follow up with
US patency of the vessels.
Conclusions:
This technique offers good cerebral and body perfu-
sion during circulatory arrest and optimal exposure of the aortic arch
and descending aorta.
