Myocardial protection
In all cases, we performed continuous blood coronary perfusion, in an effort to maintain the heart beating during aortic arch repair. To maximize myocardial protection, we shortened the duration of cardiac arrest as much as possible. We reserve cardiac arrest to perform our aorta proximal anastomosis in order to achieve a good, extensive, arch-shaped augmentation. The duration of cardiac arrest can be extended for any additional repair procedure. In their study, Lim and colleagues compared two perfusion groups involving 97 neonates operated on for CoA and HAA with VSD, IAA with VSD or aortic abnormality associated with complex cardiac malformations (16). In all cases, simultaneous cerebral and myocardial perfusion displayed superiority in terms of vasopressin use and extubation versus cerebral perfusion alone. In the most complex cases, simultaneous cerebral and myocardial perfusion was additionally shown to be superior in terms of vasoactive inotrope use, secondary sternal closure, removal of chest tubes, pleural effusion, and ICU and hospital stay duration. In our center, we apply a patch of autologous pericardium as augmentation material, preferring this approach to the direct resection/anastomosis technique. This patch technique enables us to achieve a good post-repair arch shape. While this procedure may slightly prolong the reparation in comparison with direct resection/anastomosis, we favor the anatomical outcome, along with good visceral and cerebral protection, over simple circulatory arrest duration. Our mean CCMSP duration of 51.6±21.5 minutes is roughly in line with that of the literature. In the aforementioned Meyer report using the STS database, the mean circulatory arrest duration with cerebral perfusion was 45.0 (30.0–63.0) minutes (12).