Novel Perfusion Technique for Norwood Operations: Additional Percutaneous Cannulation of the Femoral Artery for Lower Body Perfusion

Objectives: So called selective antegrade cerebral perfusion (ACP) via innominate artery is widely used during aortic arch reconstruction. However, with ACP it is unclear how much of cardiopulmonary bypass (CPB) flow reaches the lower body. We compared the outcome of hypoplastic left heart syndrome (HLHS) patients after the Norwood procedure with different perfusion strategies including additional regional splanchnic perfusion via descending aorta or femoral artery.

Methods: A total of 61 neonates with HLHS who underwent arch repair from 2012 to 2016 were included. In group I (minimal core body temperature: 18°C, n = 38) the ACP flow rate was around 80 mL/kg per min. In group II (32°C, n = 13, additional descending aorta perfusion) and group III (18°C, n = 10, additional femoral artery perfusion via percutaneously placed 4F sheath, which was removed at the end of the procedure) 50% of CPB flow (40–70 mL/kg/min) was directed to the lower and 50% to the upper body.

Results: Groups II and III demonstrated significantly lower serum lactate at the end of reperfusion (2.8 ± 1.5 and 2.8 ± 0.8 vs. 4.6 ± 1.5 mmol/L) relative to group I. In all groups there was a slight temporary postoperative increase in serum creatinine to 127% of baseline levels (p = ns). In-hospital mortality and duration of postoperative open chest and ventilation was not significantly different between the groups. In none of the groups, vascular complications or neurologic events occurred.

Conclusion: Percutaneous cannulation of the femoral artery is a new, yet simple and reproducible technique for retrograde abdominal perfusion during Norwood repairs. It has the potential to replace direct cannulation of the descending aorta, which is technically more demanding. The additional flow to the lower body allows safe complex arch repairs with almost normal lactate levels at the end of the Norwood operation.

No conflict of interest has been declared by the author(s).