Issue |
J Extra Corpor Technol
Volume 52, Number 4, December 2020
|
|
---|---|---|
Page(s) | 332 - 336 | |
DOI | https://doi.org/10.1051/ject/202052332 | |
Published online | 15 December 2020 |
Technique Article
Sustained Total All-Region (STAR) Perfusion: An Optimized Perfusion Strategy for Norwood Reconstruction
Department of Perfusion Services, Duke University Hospital, Durham, North Carolina; and Duke University School of Medicine, Durham, North Carolina
Address correspondence to: Travis Siffring, MS, CCP, FPP, Perfusion Services, Duke University Hospital, 2301 Erwin Road, DUMC 100161 Durham, NC 27710. E-mail: travis.siffring@duke.edu
Received:
20
July
2020
Accepted:
6
October
2020
Early iterations of the Norwood procedure used aortic cross-clamping, myocardial arrest, and, sometimes, deep hypothermic circulatory arrest. The resulting hypothermia and prolonged ischemia caused frequent cardiac, neurologic, renal, and other end-organ dysfunctions. Our group describes a novel technique, sustained total all-region (STAR) perfusion, which circumvents these issues by providing continuous perfusion to the head, heart, and coronaries at temperatures of 32–34°C. A single DLP® straight venous cannula (Medtronic, Minneapolis, MN) is placed in the right atrium, and a DLP® pediatric arterial cannula, with a high-flow stopcock attached, is placed in the ascending aorta or innominate artery to provide flow to the head. A cardioplegia needle with walrus tubing is connected to the stopcock to provide flow to the coronary arteries. For lower body perfusion, an olive tip cannula is placed into the descending aorta lumen and attached to the 1/8″ line from the cardioplegia system which provides warm arterial blood flow. STAR perfusion allows the Norwood procedure to be completed with mild hypothermia and continuous perfusion to all vascular beds with reduced cardiopulmonary bypass as well as total operative times. This technique is successfully achieved with minimal changes to circuitry, minor modifications to heart–lung machine servoregulation and few additional cannulation disposables.
Key words: cardiopulmonary bypass / three-region perfusion / hypoplastic left heart syndrome / ischemia / Norwood / all-region perfusion
© 2020 AMSECT
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