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J Thorac Cardiovasc Surg 2007;133:886-887
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Frank L. Hanley (San Francisco, Calif). Thank you. I have no conflicts.

I congratulate Dr Goldberg and her colleagues for a very timely study and for an excellent manuscript and presentation. Sorting out the relative neurodevelopmental morbidity of DHCA and continuous cardiopulmonary bypass in neonatal heart surgery is a major challenge. As the authors imply, this is almost impossible to achieve in a single-institution study. An important contribution of this study, however, is that it may act as a catalyst for further thought and possibly for multi-institutional analysis. I have two comments to make and then a couple of brief questions, and I hope you can bear with me. Most of them relate to technique because technique is so important in neurodevelopmental outcome in terms of what we do in the operating room as we are learning more and more.

The first comment relates to some very detailed technique issues. I hesitate to dwell on these in this forum, but I believe they are important. There are many ways to do RCP, and the details of how it is done can affect the likelihood of neural injury. The technique used in this study, using a polytetrafluoroethylene graft, which is cannulated for RCP, requires a number of minutes of little or no innominate artery perfusion during which the actual graft is being attached onto the innominate artery. In addition, the technique requires, at least as I understand it, several periods of DHCA, one when the central cannula is transferred into the graft, one when the cannula is brought back to its central position after most of the operation is done, and then when the cardioplegic solution is given, because it is given through that same cannula. So this involves three separate periods of circulatory arrest. Furthermore, as you mentioned, there . . . [Full Text of this Article]

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A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: Outcomes for infants with functional single ventricle

Caren S. Goldberg, Edward L. Bove, Eric J. Devaney, Eileen Mollen, Edward Schwartz, Shauna Tindall, Cheryl Nowak, John Charpie, Morton B. Brown, Tom J. Kulik, and Richard G. Ohye
J. Thorac. Cardiovasc. Surg. 2007 133: 880-887. [Abstract] [Full Text] [PDF]