Continuous cerebral and myocardial selective perfusion in neonatal aortic arch surgery. Issue 11 (13th August 2020)

• Record Type: Journal Article
• Authors: Maminirina, Pierre; Pavy, Carine; Bourgoin, Pierre; Baron, Olivier
• Is Part Of: Journal of cardiac surgery. Volume 35:Issue 11(2020)
• Page Start: 2920
• Page End: 2926
• Publication Date: 2020-08-13
• Subjects: aorta and great vessel -- congenital heart disease -- perfusion; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14930
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background: To assess the feasibility and early outcome of continuous cerebral and myocardial selective perfusion (CCMSP) during aortic arch surgery in neonates. Methods: We performed a single‐center retrospective study between 2008 and 2019 on neonates who underwent aortic arch surgery with or without associated heart lesion repair. CCMSP with moderate hypothermia levels (28°C) was achieved using selective brachiocephalic artery and ascending aorta cannulation. Target rates of cerebral and myocardial perfusion were 25 to 35 mL/kg/min and 150 ml/m2/min. Cardiopulmonary bypass (CPB) variables and clinical outcomes were analyzed. Results: Overall, 69 neonates underwent either isolated aortic arch repair (n = 31) or aortic arch repair with ventricular septal defect (VSD) closure (n = 38). Age and weight medians were 8 [6 to 15] days and 3.4 [2.9‐3.5] kg, respectively. Mean CPB and aortic clamping times were 134 ± 47 and 26 ± 5 minutes for isolated aortic arch repair, and 159 ± 47 and 75 ± 30 minutes for aortoplasty accompanied by VSD closure. Mean CCMSP time was 52 ± 21 minutes with cerebral rate of 32.6 ± 10 mL·kg −1 ·min −1 . Overall in hospital survival was 98.5% (68/69). Major complications were: postoperative cardiac failure requiring mechanical support followed by stroke (n = 1; 1.44%) and transient renal failure requiring dialysis (n = 2; 2.89%). Neither myocardial nor digestive complication occurred. Conclusion: CCMSP is a safe and reproducible strategy for cerebral, myocardial and visceral protection in neonatal aortic arch repair, with or without VSD closure, resulting in low complication and mortality.