- Case study
- Open Access
- Open Peer Review
Simplified aortic cannulation (SAC) – a useful technique for neonates with small aortas
© Knott-Craig et al; licensee BioMed Central Ltd. 2006
- Received: 02 March 2006
- Accepted: 28 May 2006
- Published: 28 May 2006
A simplified means of arterial cannulation for cardiopulmonary bypass in small neonates and those infants with diminutive aortas, or requiring reconstruction of the ascending aorta, is presented. It involves suturing a long 3.5 mm graft to the innominate artery and inserting the arterial cannula into the end of the graft. This technique improves exposure, thereby greatly simplifying many complex repairs, and may be used for initiation of ECMO or for hybrid procedures in the postoperative period.
- Circulatory Arrest
- Hypoplastic Left Heart Syndrome
- Hybrid Procedure
- Innominate Artery
- PTFE Graft
Cannulation of the diminutive ascending aorta in small neonates can be difficult. Not only can this result in narrowing of the aorta once the cannula is removed and the aortotomy closed, but the cannula itself may obstruct the aorta before and after cardiopulmonary bypass. This may contribute to unstable hemodynamics and complicate the process of weaning from bypass at the conclusion of the procedure.
In order to overcome these difficulties, we have utilized an alternative means of aortic cannulation which is both simple and reproducible. Furthermore, it has potential benefits for the patient in the perioperative period. We termed this "Simplified Aortic Cannulation" (SAC) and presented our initial experience with SAC at international meetings in September 2004 and 2005 . This has become our standard aortic cannulation technique for neonates requiring reconstruction of the ascending aorta or transverse aortic arch and for those neonates and small infants with small (less than 5 mm) ascending aortas.
Between February 2000 and January 2006, 86 neonates underwent cardiac procedures utilizing SAC at the Children's Hospital of Oklahoma. These included a 1300 g preterm infant with Tetralogy of Fallot, and 2 infants with Transposition of the Great Arteries weighing less than 1800 g. Also included in this group are all neonates with Hypoplastic Left heart Syndrome (n = 57) and with Interrupted Aortic Arch complex (n = 18) operated on during this period.
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