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Abstract：
BACKGROUND: A left thoracotomy approach is anatomically appropriate for childhood aortic coarctation; however, the pediatric femoral arteriovenous diameters are too small for cardiopulmonary bypass cannulation. We aimed to determine the safety of a partial cardiopulmonary bypass through the main pulmonary artery and the descending aorta in pediatric aortic coarctation repair.
METHODS: We retrospectively reviewed 10 patients who underwent coarctation repair under partial main pulmonary artery-to-descending aorta cardiopulmonary bypass with a left thoracotomy as the CPB group. During the same period, 16 cases of simple coarctation of the aorta repair, with end-to-end anastomosis through a left thoracotomy without partial CPB assistance, were included as the non-CPB group to evaluate the impact of partial CPB.
RESULTS: The median age and weight at surgery of the CPB group were 3.1 years (range, 9 days to 17.9 years) and 14.0 (range, 2.8-40.7) kg, respectively. Indications for the partial cardiopulmonary bypass with overlap were as follows: age > 1 year (n = 7), mild aortic coarctation (n = 3), and predicted ischemic time > 30 min (n = 5). Coarctation repair using autologous tissue was performed in seven cases and graft replacement in three. The mean partial cardiopulmonary bypass time, descending aortic clamp time, and cardiopulmonary bypass flow rate were 73 ± 37 min, 57 ± 27 min, and 1.6 ± 0.2 L/min/m2, respectively. Urine output during descending aortic clamping was observed in most cases in the CPB group (mean: 9.1 ± 7.9 mL/kg/h), and the total intraoperative urine output was 3.2 ± 2.7 mL/kg/h and 1.2 ± 1.5 mL/kg/h in the CPB and non-CPB group, respectively (p = 0.020). The median ventilation time was 1 day (range, 0-15), and the intensive care unit stay duration was 4 days (range, 1-16) with no surgical deaths. No major complications, including paraplegia or recurrent coarctation, occurred postoperatively during a median observation period of 8.1 (range, 3.4-17.5) years in the CPB group. In contrast, reoperation with recurrent coarctation was observed in 2 cases in the non-CPB group (p = 0.37).
CONCLUSIONS: Partial cardiopulmonary bypass through the main pulmonary artery and descending aorta via a left thoracotomy is a safe and useful option for aortic coarctation repair in children.
METHODS: We retrospectively reviewed 10 patients who underwent coarctation repair under partial main pulmonary artery-to-descending aorta cardiopulmonary bypass with a left thoracotomy as the CPB group. During the same period, 16 cases of simple coarctation of the aorta repair, with end-to-end anastomosis through a left thoracotomy without partial CPB assistance, were included as the non-CPB group to evaluate the impact of partial CPB.
RESULTS: The median age and weight at surgery of the CPB group were 3.1 years (range, 9 days to 17.9 years) and 14.0 (range, 2.8-40.7) kg, respectively. Indications for the partial cardiopulmonary bypass with overlap were as follows: age > 1 year (n = 7), mild aortic coarctation (n = 3), and predicted ischemic time > 30 min (n = 5). Coarctation repair using autologous tissue was performed in seven cases and graft replacement in three. The mean partial cardiopulmonary bypass time, descending aortic clamp time, and cardiopulmonary bypass flow rate were 73 ± 37 min, 57 ± 27 min, and 1.6 ± 0.2 L/min/m2, respectively. Urine output during descending aortic clamping was observed in most cases in the CPB group (mean: 9.1 ± 7.9 mL/kg/h), and the total intraoperative urine output was 3.2 ± 2.7 mL/kg/h and 1.2 ± 1.5 mL/kg/h in the CPB and non-CPB group, respectively (p = 0.020). The median ventilation time was 1 day (range, 0-15), and the intensive care unit stay duration was 4 days (range, 1-16) with no surgical deaths. No major complications, including paraplegia or recurrent coarctation, occurred postoperatively during a median observation period of 8.1 (range, 3.4-17.5) years in the CPB group. In contrast, reoperation with recurrent coarctation was observed in 2 cases in the non-CPB group (p = 0.37).
CONCLUSIONS: Partial cardiopulmonary bypass through the main pulmonary artery and descending aorta via a left thoracotomy is a safe and useful option for aortic coarctation repair in children.
摘要：
背景：左侧开胸手术在解剖学上适用于儿童主动脉缩窄；然而，小儿股动静脉直径太小，无法进行体外循环插管。我们旨在确定通过主肺动脉和降主动脉进行部分体外循环在小儿主动脉缩窄修复中的安全性。
方法：我们回顾性分析了10例患者在部分主肺动脉至降主动脉体外循环下进行缩窄修补术，并进行了左开胸手术作为CPB组。在同一时期,16例单纯主动脉缩窄修复术，在没有部分CPB辅助的情况下，通过左胸切开术进行端对端吻合，纳入非CPB组以评估部分CPB的影响。
结果：CPB组手术时的中位年龄和体重为3.1岁（范围，9天至17.9年)和14.0(范围，2.8-40.7)kg,分别。重叠部分体外循环的适应症如下：年龄>1岁（n=7），轻度主动脉缩窄（n=3），预测缺血时间>30分钟(n=5)。7例使用自体组织进行缩窄修复，3例进行移植物置换。平均部分体外循环时间，降主动脉钳夹时间，体外循环流速为73±37分钟，57±27分钟,和1.6±0.2L/min/m2。在CPB组中，大多数情况下观察到降主动脉钳夹期间的尿量（平均：9.1±7.9mL/kg/h），CPB组和非CPB组术中总尿量分别为3.2±2.7mL/kg/h和1.2±1.5mL/kg/h,分别(p=0.020)。中位通气时间为1天(范围，0-15),重症监护病房住院时间为4天(范围，1-16）无手术死亡。无重大并发症,包括截瘫或复发性缩窄，发生在术后中位观察期8.1(范围，CPB组3.4-17.5）年。相比之下,在非CPB组中观察到2例复发缩窄的再手术（p=0.37）。
结论：经左侧开胸手术经主肺动脉和降主动脉的部分体外循环是儿童主动脉缩窄修复的安全和有用的选择。
方法：我们回顾性分析了10例患者在部分主肺动脉至降主动脉体外循环下进行缩窄修补术，并进行了左开胸手术作为CPB组。在同一时期,16例单纯主动脉缩窄修复术，在没有部分CPB辅助的情况下，通过左胸切开术进行端对端吻合，纳入非CPB组以评估部分CPB的影响。
结果：CPB组手术时的中位年龄和体重为3.1岁（范围，9天至17.9年)和14.0(范围，2.8-40.7)kg,分别。重叠部分体外循环的适应症如下：年龄>1岁（n=7），轻度主动脉缩窄（n=3），预测缺血时间>30分钟(n=5)。7例使用自体组织进行缩窄修复，3例进行移植物置换。平均部分体外循环时间，降主动脉钳夹时间，体外循环流速为73±37分钟，57±27分钟,和1.6±0.2L/min/m2。在CPB组中，大多数情况下观察到降主动脉钳夹期间的尿量（平均：9.1±7.9mL/kg/h），CPB组和非CPB组术中总尿量分别为3.2±2.7mL/kg/h和1.2±1.5mL/kg/h,分别(p=0.020)。中位通气时间为1天(范围，0-15),重症监护病房住院时间为4天(范围，1-16）无手术死亡。无重大并发症,包括截瘫或复发性缩窄，发生在术后中位观察期8.1(范围，CPB组3.4-17.5）年。相比之下,在非CPB组中观察到2例复发缩窄的再手术（p=0.37）。
结论：经左侧开胸手术经主肺动脉和降主动脉的部分体外循环是儿童主动脉缩窄修复的安全和有用的选择。
