Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

Abstract

The results of neonatal aortic arch surgery using cerebro‐myocardial perfusion were analyzed. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard perfusion, using a single pump rotor with an arterial line Y‐connector. Between May 2008 and May 2016, 69 consecutive neonates underwent arch repair using either selective cerebro‐myocardial perfusion (Group A, n = 34) or standard perfusion (Group B, n = 35). The groups were similar for age, weight, BSA, prevalence of one‐stage or staged repair, and single ventricle palliation; male gender was more frequent in Group A. The duration of the cerebro‐myocardial perfusion was comparable (27 ± 8 vs. 28 ± 7 min, P = 0.9), with higher flows in Group A (57 ± 27 vs. 39 ± 19 mL/kg/min, P = 0.01). Although cardioplegic arrest was more common in Group B (13/34 vs. 23/35, P = 0.03), the duration of myocardial ischemia was longer in Group A (64 ± 41 vs. 44 ± 14 min, P = 0.04). There was 1 hospital death in each group, with no permanent neurological injury in either group. Cardiac morbidity (1/34 vs. 7/35, P = 0.02) was more common in Group B, while extracardiac morbidity was similar in both the groups. During follow‐up (3.2 ± 2.4 years), 5 late deaths occurred with a comparable 5‐year survival rate (75 ± 17% vs. 88 ± 6%, P = 0.7) and freedom from arch reintervention (86 ± 6% vs. 84 ± 7%, P = 0.6). Risk of cardiac morbidity was greater with standard cerebro‐myocardial perfusion (OR = 5.2, CI 3.3–6.8, P = 0.001) and with perfusion flows less than 50 mL/kg/min (OR 3.7, CI 1.87–5.95, P = 0.04). Cerebro‐myocardial perfusion is a safe and effective strategy to protect the brain and heart in neonates undergoing arch repair. Selective techniques using higher perfusion flows may further attenuate cardiac morbidity.

Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery

“…With the progress of surgical techniques, some perfusionists have gradually increased the perfusion temperature during RCP, thus shortening the cardiopulmonary bypass time significantly. Compared with systemic DHCA strategy in the past, the incidence of hypothermia‐related coagulation diseases, renal dysfunctions, nervous system impairments, and the recurrent occlusion after neonatal aortic arch operations were dramatically decreased. Prognosis of neonates improved significantly .…”

“…Simple regional cerebral perfusion (SRCP) or cerebro‐myocardial perfusion (CMP) strategy has been widely used in one‐stage aortic arch repair operations in pediatric patients, which has gradually replaced deep hypothermic circulatory arrest (DHCA). In order to maintain continuous heartbeats, a higher temperature is usually adopted in CMP compared with SRCP, thus shortening the time of cooling, rewarming, and cardiopulmonary bypass (CPB).…”

Artificial Organs 2019: A year in review

“…Giovanni Battista Luciani et al of the University of Verona, Verona, Italy analyzed the results of neonatal aortic arch surgery using cerebro‐myocardial perfusion. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard perfusion, using a single pump rotor with an arterial line Y‐connector.…”

Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

“…Aortic coarctation (CoAo) is a common congenital heart disease (CHD), occurring in approximately 4 out of 10,000 live births [ 1 , 2 ], which may be isolated or complex, when associated with other CHDs, such as a bicuspid aortic valve (BAV), ventricular septal defect (VSD), and hypoplastic aortic arch (HAA) [ 3 ]. In particular, HAA repair in either isolated or complex aortic coarctation may be associated with significant morbidity [ 4 , 5 ].…”