MHCA with SACP versus DHCA in Pediatric Aortic Arch Surgery: A Comparative Study

Ling Xie,Harness Lynn,Xiao Hu,Mao Ye,Guijin Huang,Shiyu Shu,Yan Xu

doi:10.1038/s41598-020-61428-x

Abstract

The safety and efficacy of selective antegrade cerebral perfusion (SACP) in children undergoing aortic arch surgery are unclear. In this retrospective analysis, we compared moderate hypothermic circulatory arrest (MHCA; n = 61) plus SACP vs deep hypothermic circulatory arrest (DHCA; n = 53) in children undergoing aortic arch surgery during a period from January 2008 to December 2017. Demographic characteristics and the underlying anomalies were comparable between the two groups. The MHCA + SACP group had shorter cardiopulmonary bypass (CPB) time (146.9 ± 40.6 vs 189.6 ± 41.2 min for DHCA; p < 0.05) and higher nasopharyngeal temperature (26.0 ± 2.1 vs 18.9 ± 1.6 °C; p < 0.01). The MHCA + SACP group had lower rate of neurologic complications (3/61 vs 10/53 for DHCA; p < 0.05) but not complications in other organ systems. The MHCA + SACP group also had less 24-hour chest drainage (median, interquartile rage: 28.9, 12.6–150.0 vs 47.4, 15.2–145.0 ml/kg for DHCA; p < 0.05), shorter duration of postoperative mechanical ventilation (35.0, 15.4–80.3 vs 94.0, 42.0–144.0 h; p < 0.01), and shorter stay in intensive care unit (3.9, 3.0–7.0 vs 7.7, 5.0–15.0 d; p < 0.05). In regression analysis, in-hospital mortality was associated with longer CPB time. In conclusion, MHCA + SACP is associated with better short-term outcomes in children receiving aortic arch surgery under CPB.

Highlights

Coarctation of the aorta (CoA) and interrupted aortic arch (IAA) are the most common congenital large vascular malformations[1]
Several studies suggested that selective antegrade cerebral perfusion (SACP) in combination with mild hypothermia could provide sufficient cerebral protection in aortic arch surgery that typically lasted for at least 90 minutes[7,8]
Surgery was conducted under deep hypothermic circulatory arrest (DHCA) in 53 cases and under moderate hypothermic circulatory arrest (MHCA) + SACP in the remaining 61 cases

Summary

Introduction

Coarctation of the aorta (CoA) and interrupted aortic arch (IAA) are the most common congenital large vascular malformations[1]. Deep hypothermic circulatory arrest (DHCA) is routinely used in aortic arch surgeries that require CPB to minimize cerebral metabolism and to provide clean surgical field[2], but may lead to hypothermia-induced coagulopathy, capillary leak syndrome, microvasculature endothelial dysfunction, elevated systemic inflammatory response and multiple organ dysfunctions[3]. SACP has been increasingly used with mild hypothermia or normothermia in aortic arch surgery[6]. Several studies suggested that SACP in combination with mild hypothermia (core temperature at 30 °C) could provide sufficient cerebral protection in aortic arch surgery that typically lasted for at least 90 minutes[7,8]. In the current retrospective analysis, we used relatively larger number of cases to compare moderate hypothermic circulatory arrest (MHCA) in combination with SACP versus DHCA alone in children undergoing CoA/IAA surgery

Methods

Results

Conclusion