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Norwood Reconstruction Using Continuous Coronary Perfusion: A Safe and Translatable Technique Joseph W. Turek, MD, PhD, Robert A. Hanfland, MD, Tina L. Davenport, ARNP, Jose E. Torres, MD, David A. Duffey, BSN, CCP, Sonali S. Patel, MD, PhD, Benjamin E. Reinking, MD, Patrick M. Poston, BS, James E. Davis, MD The Annals of Thoracic Surgery Volume 96, Issue 1, Pages (July 2013) DOI: /j.athoracsur Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions
Fig 1 Illustrations of cerebral and coronary perfusion strategies used during beating-heart Norwood neoaortic reconstruction. (A) Continuous cerebral and coronary perfusion is provided by a 3.5- or 4-mm graft sewn onto the innominate artery. Selective clamping of the descending aorta, left subclavian artery, left common carotid artery, and proximal aortic arch enables aortic arch augmentation. For the ascending aortic reconstruction, only antegrade cerebral perfusion continues to be supplied through the innominate artery graft because a clamp is placed on the proximal vessel. Concurrently, continuous coronary perfusion is maintained through an accessory cannula placed in the ascending aorta proximal to the augmentation. (B) A cardioplegia spike can be used for larger diameter aortas with a clamp placed just distally to the spike. (C) For smaller ascending aortic diameters, an olive-tip cannula is placed into the lumen of the opened aorta and directed towards the root. A vessel loop tourniquet can be used to secure the cannula. The Annals of Thoracic Surgery , DOI: ( /j.athoracsur ) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions
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