Table 1.

Texas Children’s Hospital Antegrade Cerebral Perfusion Technique

1.	3.5 mm PTFE graft to right innominate artery, after 100 units/kg heparin, with 8–0 prolene sutures
2.	10 fr standard aortic cannula to distal end of graft
3.	Single atrial or bicaval cannulation
4.	Use bilateral bifrontal NIRS and TCD through anterior fontanelle or temporal window for cerebral physiological monitoring.
5.	Establish baseline mean cerebral blood flow velocity using TCD, and rSO2 using NIRS, at 18–22° C, at full flow CPB: 150 ml/kg/min; MAP 30–35 mm Hg; utilize α-receptor blockade with phentolamine or phenoxybenzamine if necessary. (rSO2normally 90–95% bilaterally, mean CBFV normally 18–25 cm/sec).
6.	Use pH stat management, hct 30–35, all phases of CPB.
7.	ACP initiated after brief DHCA for atrial septectomy for Norwood: all brachiocephalic vessels and descending thoracic aorta snared; temperature always 18° C: begin at 37.5 ml/kg/min.
8.	Adjust ACP flow using TCD to achieve CBFV within ±10% of baseline at full CPB flow.
9.	rSO2 should be within ±10% of baseline, or 90–95% bilaterally; if left rSO2 falls to more than 10% below right, increase ACP flow.

Abbreviations: PTFE, polytetrafluroethylene; NIRS, near-infrared spectroscopy; TCD, transcranial Doppler; rSO₂, regional brain oxygen saturation; CPB; cardiopulmonary bypass; MAP, mean arterial pressure; CBFV; cerebral blood flow velocity; ACP, antegrade cerebral perfusion; DHCA, deep hypothermic circulatory arrest