We developed a technique for the Norwood operation utilizing continuous perfusion
of the head, heart, and lower body at mild hypothermia named Sustained Total All-Region
(STAR) perfusion. We hypothesized that STAR perfusion would be associated with shorter
operative times, decreased coagulopathy, and expedited post-operative recovery compared
to standard perfusion techniques. Between 2012 and 2020, 80 infants underwent primary
Norwood reconstruction at our institution. Outcomes for patients who received successful
STAR perfusion (STAR, n = 37) were compared to those who received standard Norwood
reconstruction utilizing regional cerebral perfusion only (SNR, n = 33), as well as
to Norwood patients reported in the PC4 national database during the same timeframe (n = 1238). STAR perfusion was performed
with cannulation of the innominate artery, descending aorta, and aortic root at 32-34°C.
STAR patients had shorter median CPB time compared to SNR (171 vs 245 minutes, P < 0.0001), shorter operative time (331 vs 502 minutes, P < 0.0001), and decreased intraoperative pRBC transfusion (100 vs 270 mL, P < 0.0001). STAR patients had decreased vasoactive-inotropic score on ICU admission
(6 vs 10.8, P = 0.0007) and decreased time to chest closure (2 vs 4.5 days, P = 0.0004). STAR patients had lower peak lactate (8.1 vs 9.9 mmol/L, P = 0.03) and more rapid lactate normalization (18.3 vs 27.0 hours, P = 0.003). In-hospital mortality in STAR patients was 2.7% vs 15.1% with SNR (P = 0.06) and 10.3% in the PC4 aggregate (P = 0.14). STAR perfusion is a novel approach to Norwood reconstruction associated with
excellent survival, decreased transfusions, shorter operative time, and improved convalescence
in the early post-operative period.
GRAPHICAL ABSTRACT
Graphical Abstract
Keywords
Abbreviations:
ACP (Antegrade Cerebral Perfusion), CICU (Cardiac Intensive Care Unit), CPB (Cardiopulmonary Bypass), DHCA (Deep Hypothermic Circulatory Arrest), DKS (Damus-Kaye-Stansel), PC4 (Pediatric Cardiac Critical Care Consortium), RV-PA (Right Ventricle-Pulmonary Artery), STAR (Sustained Total All-Region), SNR (Standard Norwood Reconstruction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 13, 2022
Footnotes
Funding: Dr Nellis is supported by a NIH T32 in clinical pharmacology (1T32HD104576).
Institutional Review Board: Pro00101549 (May 19, 2020)
Informed Consent Statement: The Institutional Review Board (IRB) or equivalent ethics committee of the Duke University Medical Center approved the study protocol and publication of data. Patient written consent for the publication of the study data was waived by the IRB due to the retrospective nature of the study.
Conflicts of Interest: The authors have no relevant disclosures.
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