The effects of two perfusion methods in the treatment of left coronary artery abnormality originated from pulmonary artery
Chenghu Liu, Pei Cheng, Aijun Liu, Bin Li, Zhiyi Wang, Junwu Su · Chinese Journal of Thoracic and Cardiovaescular Surgery · 2019
Objective To investigate the applicate effects in the treatment of left coronary artery abnormality originated from pulmonary artery(ALCAPA) with two perfusion methods of Medium-low temperature-full flow and Low-temperature- low flow. Methods From April 2010 to August 2018, 51 children with ALCAPA were treated with direct coronary artery transplantation in Beijing Anzhen Hospital. According to the circulated perfusion method, All of cases were divided into two groups: the Medium-low temperature full flow(group A) and Low-temperature low flow(group B); All patients underwent ALCAPA correct operation under general anesthesia by intravenous inhalation and extracorporeal circulation, and the combined cardiac malformations at the same period. Results The whole of 51 children, including 27 males and 24 females, the aweraged age was(29.19±19.43)months(8-36 months), the aweraged weight was(11.73±9.99)kg(7.4-35.0 kg). The cardiothoracic ratio(C/T) was 0.70±0.09. In group A, 24 patients, including 13 males and 11 females, the aweraged age 3-36(28.64±16.30) months, the aweraged weight 7.4-31.0(12.25±10.33) kg, and the cardiothoracic ratio(C/T) 0.71±0.07. Group B included 27 patients, including 15 males and 12 females, the aweraged age 5-31(25.85±16.60) months, the aweraged weight 6.7-35.0(10.38±3.67)kg, and the cardiothoracic ratio(C/T) of 0.69±0.06. The postoperative early death were 5 cases in the whole group, there were 3 cases in group A and 2 cases in group B, all of them were died of low cardiac output syndrome. Extracorporeal membrane oxygenation(ECMO) support for 7 cases of 5 in group A and 2 in group B. There was no statistically significant difference in in-hospital mortality between the two groups(P>0.05). The Intraoperative extracorporeal circulation time, ascending aorta occlusion time, the number and amount of myocardial cold arrest fluid perfusion, postoperative extracorporeal circulation assistance time, the incidence of ventricular fibrillation, ICU residence time, and ventilator assistance time were significantly lower in group B than group A, all with statistically significant differences(P<0.05). A total of 42 cases were followed up after the operation, the follow-up time 17(3-29) months and the left ventricular ejection fraction increased from 0.53±0.15 to 0.66±0.14(P<0.05), there was no statistically significant difference between two groups. Conclusion The perfusion modes of Low-temperature- low flow in the correct operation of ALCAPA can effectively shorten the time of aortic occlusion, improve the effect of intraoperative myocardial protection, reduce intraoperative visual field return blood volume, and reduce postoperative low cardiac output. To improve the curative effect of operation. Key words: Perfusion modes; Congenital heart diseases; Cardiac surgical procedures