Sustained Total All-Region Perfusion During the Norwood Operation and Postoperative Recovery

• Published in: Seminars in thoracic and cardiovascular surgery 2023-01, Vol.35 (1), p.140-147
• Main Authors: Prabhu, Neel K., Nellis, Joseph R., Meza, James M., Benkert, Abigail R., Zhu, Alexander, McCrary, Andrew W., Allareddy, Veerajalandhar, Andersen, Nicholas D., Turek, Joseph W.
• Format: Article
• Language: English
• Subjects: All-region perfusion; Aorta; Congenital heart; Humans; Infant; Ischemia; Lactic Acid; Neonate; Norwood; Norwood operation; Norwood Procedures - methods; Perfusion - methods; STAR perfusion; Treatment Outcome
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2022.02.003

We developed a technique for the Norwood operation utilizing continuous perfusion of the head, heart, and lower body at mild hypothermia named Sustained Total All-Region (STAR) perfusion. We hypothesized that STAR perfusion would be associated with shorter operative times, decreased coagulopathy, and expedited post-operative recovery compared to standard perfusion techniques. Between 2012 and 2020, 80 infants underwent primary Norwood reconstruction at our institution. Outcomes for patients who received successful STAR perfusion (STAR, n = 37) were compared to those who received standard Norwood reconstruction utilizing regional cerebral perfusion only (SNR, n = 33), as well as to Norwood patients reported in the PC4 national database during the same timeframe (n = 1238). STAR perfusion was performed with cannulation of the innominate artery, descending aorta, and aortic root at 32-34°C. STAR patients had shorter median CPB time compared to SNR (171 vs 245 minutes, P < 0.0001), shorter operative time (331 vs 502 minutes, P < 0.0001), and decreased intraoperative pRBC transfusion (100 vs 270 mL, P < 0.0001). STAR patients had decreased vasoactive-inotropic score on ICU admission (6 vs 10.8, P = 0.0007) and decreased time to chest closure (2 vs 4.5 days, P = 0.0004). STAR patients had lower peak lactate (8.1 vs 9.9 mmol/L, P = 0.03) and more rapid lactate normalization (18.3 vs 27.0 hours, P = 0.003). In-hospital mortality in STAR patients was 2.7% vs 15.1% with SNR (P = 0.06) and 10.3% in the PC4 aggregate (P = 0.14). STAR perfusion is a novel approach to Norwood reconstruction associated with excellent survival, decreased transfusions, shorter operative time, and improved convalescence in the early post-operative period. [Display omitted]