Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion

Kornilov, Igor; Sinelnikov, Yuri S.; Soynov, Ilya; Ponomarev, Dmitry; Kshanovskaya, M. S.; Krivoshapkina, Aleksandra A.; Горбатых, А. В.; Omelchenko, Alexander

doi:10.1093/ejcts/ezv235

Cited by 59 publications

(70 citation statements)

References 23 publications

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“…It is generally agreed that more prolonged periods of uninterrupted circulatory arrest will result in an increased risk of adverse neurological outcomes (66, 67). Close inspection of the data, however, shows that the effects of short durations of circulatory arrest are inconsistently related to adverse outcomes, and that the effect of circulatory arrest is not a linear phenomenon.…”

Section: Deep Hypothermic Circulatory Arrestmentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Wernovsky¹,

Licht²

2016

Pediatric Critical Care Medicine

201

143

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Objectives The objectives of this review are to discuss the scope of neurologic injuries in newborns with congenital heart disease, the mechanisms of injury, including pre-natal, pre- intra- and postoperative factors, neurodevelopmental outcomes and therapeutic strategies for the timely intervention and prevention of neurologic injury. Data Source MEDLINE, PubMed Conclusion At the current time, important research is underway to (1) better understand the developing brain in the fetus with complex congenital heart disease, (2) to identify modifiable risk factors in the operating room and intensive care unit in order to maximize long-term neurodevelopmental outcomes and (3) develop strategies to improve family psychosocial health, childhood development and health-related quality of life following hospital discharge. Crucial in this effort is the identification of an early post-operative surrogate variable with good predictive validity for long-term outcomes. If an appropriate surrogate variable for long term outcomes can be identified, and measured relatively early after surgical intervention for complex congenital heart disease, reliable clinical trials can be undertaken to improve upon current outcomes.

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Section: Deep Hypothermic Circulatory Arrestmentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Wernovsky¹,

Licht²

2016

Pediatric Critical Care Medicine

201

143

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“…However, with the current EEEA technique, our reintervention rate for recoarctation has been very low (4.5%). Also, although other authors did not find significant differences in outcome, EEEA with CPBP and DHCA exposes undoubtedly the patient to increased risk of cerebral injury . Thus, since the need for reintervention on aortic arch has been very infrequent in our series, and most commonly balloon dilation was an effective treatment for late recoarctation, we believe that EEEA with no CPBP through a thoracotomy remains the optimal approach to treat CoAo even when HAA is associated.…”

Section: Resultsmentioning

confidence: 54%

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

et al. 2019

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Background To evaluate early and long‐term results of surgical treatment of aortic coarctation (CoAo) in infants and children. Methods A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. Results Three hundred forty‐one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10‐143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end‐to‐end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty‐day mortality was 1.4%. At a median follow‐up of 10.2 years (IQR, 6‐15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. Conclusions Surgical repair of CoAo by EEEA without CPBP is a safe and low‐risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long‐term, and only a few require antihypertensive therapy.

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“…However, methods for conducting safe circulatory arrest are debated. Most surgeons perform circulatory arrest based on body temperature or cooling time, and there is a great deal of controversy regarding the superiority of moderate versus deep hypothermia …”

Section: Discussionmentioning

confidence: 99%

Intraoperative Electroencephalogram-Guided Deep Hypothermia Plus Antegrade and/or Retrograde Cerebral Perfusion During Aortic Arch Surgery

Murashita

Pochettino

2016

J Card Surg

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Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion

Abstract: Aortic arch reconstruction accompanied by SACP has a lower risk of neurological complications compared with DHCA. However, the high incidence of renal complications with SACP requires further study.

Cited by 59 publications

References 23 publications

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Neurodevelopmental Outcomes in Children With Congenital Heart Disease—What Can We Impact?

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

Intraoperative Electroencephalogram-Guided Deep Hypothermia Plus Antegrade and/or Retrograde Cerebral Perfusion During Aortic Arch Surgery

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