Neck cannulation for bypass in redo sternotomy in children and adults with congenital heart disease. (1st April 2020)

• Record Type: Journal Article
• Authors: Mustafa, Muhammad R; Neijenhuis, Ralph M L; Furci, Barbara; Tsang, Victor T
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 31:Number 1(2020)
• Page Start: 108
• Page End: 112
• Publication Date: 2020-04-01
• Subjects: Neck cannulation -- Peripheral cardiopulmonary bypass -- Redo sternotomy -- Near-infrared spectroscopy; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivaa045
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Patients with complex congenital heart disease carry an increased risk of damage to retrosternal structures each time they undergo redo sternotomy. The aim of this study was to evaluate the safety and efficacy of neck cannulation for peripheral cardiopulmonary bypass to alleviate the risks in high-risk redo sternotomy patients. METHODS: Children and adults with congenital heart disease undergoing high-risk redo sternotomy were included in this retrospective study. The primary outcome was the safety and efficacy of neck cannulation for cardiopulmonary bypass. The secondary outcome was to assess preoperative risk factors as an indication for neck cannulation. The right common carotid artery and right internal jugular vein were cannulated and full cardiopulmonary bypass was initiated with vacuum-assisted venous drainage. Redo sternotomy was performed on a decompressed heart, and bifrontal regional cerebral oxygen saturation was monitored via near-infrared spectroscopy. RESULTS: In total, 35 patients were included. No mortality, neurological or vascular complications occurred postoperatively. Mean left- and right-sided near-infrared spectroscopy were 70.0% (±10.5) and 64.2% (±12.0), respectively, and the mean difference was 5.7% (±6.9). Main preoperative risk factors were; adherent ascending aorta (45.7%), adherent conduit (40%), severely dilated retrosternal right ventricle (17.1%) and skeletal deformations (14.3%). CONCLUSIONS: Cannulation of the right neck vessels for peripheral cardiopulmonary bypass prior to high-risk redo sternotomy in children and adults with congenital heart disease is a safe and effective strategy. In combination with near-infrared spectroscopy monitoring, adequate cerebral oxygenation can be ensured while the risk of catastrophic haemorrhage is minimized.