Heart transplantation for hypoplastic left heart syndrome: modified technique for reducing circulatory arrest time.

BACKGROUND: The surgical technique of heart transplantation as therapy in infants with hypoplastic left heart syndrome was first reported over a decade ago. Since that time, incremental refinements have evolved that both facilitate the operation and potentially reduce the perceived neurologic hazards associated with the use of hypothermic circulatory arrest. METHODS: Minor technical adjustments have permitted infant heart transplantation to be accomplished with relative ease while markedly limiting the need for complete circulatory arrest. Low-flow hypothermic systemic perfusion is used for atrial implantation, reserving circulatory arrest for arch reconstruction only. This is accomplished by use of an active (pump) sucker for venous return. RESULT: Mean circulatory arrest time with the current technique has been 26 minutes. CONCLUSION: Minor technical refinements have resulted in a marked reduction in hypothermic circulatory arrest time during infant heart transplantation for hypoplastic left heart syndrome.