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Principles of antegrade cerebral perfusion during arch reconstruction in newborns/infants
- Source :
- Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual.
- Publication Year :
- 2008
-
Abstract
- Antegrade cerebral perfusion (ACP) is a cardiopulmonary bypass technique that uses special cannulation procedures to perfuse only the brain during neonatal and infant aortic arch reconstruction. It is used in lieu of deep hypothermic circulatory arrest (DHCA), and thus has the theoretical advantage of protecting the brain from hypoxic ischemic injury. Despite this, recent comparative studies have shown no difference in neurodevelopmental outcomes with ACP versus DHCA for neonatal arch repair. This article presents animal and human data demonstrating that ACP flows less than 30 mL/kg/min are inadequate for many patients, and may be the explanation for lack of outcome difference versus DHCA. A technique for ACP, its physiologic basis, and a neuromonitoring strategy are presented, and then the results of an outcome study are reviewed, showing that with ACP technique at higher flows of 50 to 80 mL/kg/min guided by neuromonitoring, periventricular leukomalacia is eliminated on postoperative brain magnetic resonance imaging after neonatal cardiac surgery.
- Subjects :
- Aortic arch
medicine.medical_specialty
Ultrasonography, Doppler, Transcranial
Aorta, Thoracic
Article
law.invention
law
medicine.artery
Internal medicine
medicine
Cardiopulmonary bypass
Animals
Humans
Cerebral perfusion pressure
Hypoxic ischemic
Periventricular leukomalacia
Cardiopulmonary Bypass
business.industry
Infant, Newborn
Infant
medicine.disease
Cardiac surgery
Transcranial Doppler
Anesthesia
Cerebrovascular Circulation
Pediatrics, Perinatology and Child Health
Hypoxia-Ischemia, Brain
Deep hypothermic circulatory arrest
Cardiology
Surgery
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10929126
- Database :
- OpenAIRE
- Journal :
- Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
- Accession number :
- edsair.doi.dedup.....6ff40aaf3d6e5242dd2367031fe56664