Selective Cerebro ‐Myocardial Perfusion in Complex Neonatal Aortic Arch Pathology: Midterm Results

Abstract Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro‐myocardial protection was recently developed, where regional low‐flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short‐term and mid‐term results of selective and independent cerebro‐myocardial perfusion in neonatal aortic arch surgery. From April 2008 to August 2015, 28 consecutive neonates underwent aortic arch surgery under cerebro‐myocardial perfusion. There were 17 male and 11 female, with median age of 15 days (3–30 days) and median body weight of 3 kg (1.6–4.2 kg), 9 (32%) of whom with low body weight (<2.5 kg). The spectrum of pathologies treated was heterogeneous and included 13 neonates having single‐stage biventricular repair (46%), 7 staged biventricular repair (25%), and 8 single‐ventricle repair (29%). All operations were performed under moderate hypothermia and with a “beating heart and brain.” Average cardiopulmonary bypass time was 131 ± 64 min (42–310 min). A period of cardiac arrest to complete intra‐cardiac repair was required in nine patients (32%), and circulatory arrest in 1 to repair total anomalous pulmonary veno...
Source: Artificial Organs - Category: Transplant Surgery Authors: Tags: Thoughts and Progress Source Type: research