A technique for performing antegrade selective cerebral perfusion without interruption of forward flow or cannula relocation for pediatric aortic arch reconstruction

New technology and advances in extracorporeal bypass circuitry and surgical techniques have drastically improved outcomes in infants with congenital heart defects. Hypothermia with circulatory arrest has fallen out of favor in many institutions over the last decade in part from data implicating even short circulatory arrest times to long-term neurologic sequelae. Implementing continuous cerebral perfusion techniques for aortic arch reconstruction is desirable in ameliorating neurologic complications because long-term survival of complex defects can be more routinely achieved. Many centers have implemented alternative means of alleviating cerebral ischemic periods by incorporating selective antegrade or retrograde cerebral perfusion techniques. The incidence of post-operative neurologic events is low when alternative cerebral perfusion techniques are used. Many techniques used to perform continuous cerebral perfusion involve brief periods of circulatory arrest, usually for perfusion cannula repositioning. Herein we describe a technique for performing continuous antegrade cerebral perfusion without a need to interrupt forward flow.