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.

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

Luciani, Giovanni Battista
;
Hoxha, Stiljan;Rungatscher, Alessio;Caputo, Massimo;
2019-01-01

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.
aortic arch hypoplasia
aortic arch surgery
cerebral perfusion
coarctation
interrupted aortic arch
myocardial perfusion
neonate
Cerebrovascular Circulation
Cohort Studies
Coronary Vessels
Equipment Design
Female
Humans
Infant, Newborn
Male
Perfusion
Treatment Outcome
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1030935
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