The Norwood Operation With Innominate Artery and Descending Aortic Cannulation, Performed With Continuous Mildly Hypothermic Bypass

Conventional perfusion technique for the Norwood operation relies on deep hypothermia for protection of the body during construction of the neoaortic arch, with or without the provision of cold antegrade perfusion into the cerebral circulation. Bypass time required for cooling and warming, the exposure of the lower body to prolonged ischemia, and the effects of hypothermia itself, may contribute to postoperative oliguria and third-space fluid gain, and may prolong recovery. In this article, a technique is presented for exposure and cannulation of the descending aorta. This, combined with direct cannulation of the innominate artery, allows continuation of full-flow bypass to the entire body throughout repair, and obviates the use of deep hypothermia. Modifications of the conduct of operation are presented which take advantage of the absence of cardiopulmonary bypass time spent cooling and warming to reduce the overall duration of bypass and myocardial ischemia.