Selective visceral perfusion improves renal flow and hepatic function in neonatal aortic arch repair

Abstract

Selective visceral perfusion is a safe procedure that provides a better urine output, hepatic function and tissue perfusion. This technique allows for the repair of complex aortic arch anomalies in neonates without deep hypothermic circulatory arrest.

Selective lower body perfusion during aortic arch surgery in neonates and small children

“…To address this problem, different approaches have been developed in an attempt to improve the splanchnic and renal perfusion through cannulation of the descending aorta, femoral artery, or umbilical artery. 5 , 7 – 9 These studies have shown an improvement of the renal function, lactate levels and ICU length of stay when compared with mild hypothermia and ACP. 5 – 7 , 9 However, only one group has published an LBP approach utilizing a different cannulation site than the descending aorta either by the use of the umbilical or femoral artery utilizing a 3.5F (n = 9 patients) and 3F (n = 4 patients) arterial sheath, respectively.…”

“… 5 , 7 – 9 These studies have shown an improvement of the renal function, lactate levels and ICU length of stay when compared with mild hypothermia and ACP. 5 – 7 , 9 However, only one group has published an LBP approach utilizing a different cannulation site than the descending aorta either by the use of the umbilical or femoral artery utilizing a 3.5F (n = 9 patients) and 3F (n = 4 patients) arterial sheath, respectively. 5 The patient cohort which underwent surgery with LBP showed improved renal function, implying an adequate perfusion using both approaches; 5 by avoiding any degree of acute kidney injury the morbidity and mortality at the ICU is reduced.…”

“…Although the postoperative results have improved compared with DHCA alone, there is still a certain degree of acute kidney injury (high creatinine levels) and elevated lactate levels can be seen in the reperfusion phase intraoperatively and postoperatively at the ICU. 7 – 9 The lactate level reflects the amount of lower body ischemia due to circulatory arrest in this situation. Avoiding lower body and splanchnic ischemia might improve patients’ outcomes as organ dysfunction is avoided.…”

“… 4 Recently, centers around the world have described different techniques to cannulate the descending aorta during aortic arch surgery to ensure renal and splanchnic perfusion. 5 – 7 These techniques have shown to reduce end organ damage in the lower body, leading to even shorter ICU stay, lower lactate levels, and a lower risk for kidney injury. 2 , 7 – 9 The aforementioned techniques range from an infradiaphragmatic cannulation to a left thoracotomy or even a direct cannulation during arch reconstruction through the anastomosis.…”

“… 5 – 7 These techniques have shown to reduce end organ damage in the lower body, leading to even shorter ICU stay, lower lactate levels, and a lower risk for kidney injury. 2 , 7 – 9 The aforementioned techniques range from an infradiaphragmatic cannulation to a left thoracotomy or even a direct cannulation during arch reconstruction through the anastomosis. 6 – 8 These techniques, while effective, require manipulation and extensive preparation in order to reach the aorta at the desired cannulating segment and may lead to vessel or organ injury and increases surgery time.…”