Resuscitating the PTFE Graft-to-Innominate Artery After Neonatal Arch Reconstructions: Straightforward Access for Arterial Cannulation

Prior to sternal closure, at the end of surgery involving neonatal arch reconstruction using a PTFE graft-to-innominate artery for antegrade cerebral perfusion, the graft is clipped flush to the artery, milked empty with a second clip placed at a few centimeters, and tacked to the upper sternal border, in anticipation for easy retrieval during sternal reentry. Months later at stage II palliation in univentricular hearts or PA debanding and complete intracardiac repair in biventricular lesions, the graft is resuscitated and used for expeditious arterial cannulation (using an 8F or even a 10F cannula: both can fit to use in infants of more than 5-6 kg). The technique is highly reproducible, has been successful in 90/92 infants, has not induced clinically noticeable thromboembolism, and avoids the need for dissection of a patched aorta/DKS anastomosis. In the case of unexpected malignant arrhythmias, cardiac distension or injury with bleeding during sternal reentry, it may allow expeditious and life-saving access to cardiopulmonary bypass to decompress the heart and recover shed blood.

References

1. Nasirov T, Mainwaring RD, Reddy VM, Sleasman J, Margetson T, Hanley FL. Innominate artery cannulation and antegrade cerebral perfusion for aortic arch reconstruction in infants and children. World J Pediatr Congenit Heart Surg. 2013;4:356-361.
2. Knott-Craig CJ, Pastuszko P, Overholt ED. Simplified aortic cannulation (SAC) - a useful technique for neonates with small aortas. J Cardiothorac Surg, 2006;1:13.

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