Risk assessment of renal and neurological complications in newborn after aortic reconstruction

Abstract

Introduction. Optimal cerebral and visceral protection is crucial in aortic arch surgery. The main method for this protection has traditionally been deep hypothermic circulatory arrest. Recently, antegrade cerebral perfusion with moderate hypothermia has become the most widespread strategy for adults and some children undergoing aortic arch surgery. Objectives. Continuous cerebral perfusion should reduce the incidence of neurological complications, but the degree of damage to organs and systems resulting from lack of blood flow distal to the aortic arch remains unclear. Methods. The purpose of this study was to evaluate the efficacy and safety of methods of protecting the brain and internal organs during aortic arch surgery in infants. 62 patients who underwent aortic arch reconstruction were retrospectively reviewed to assess their neurological status and internal injuries after different methods of cerebral protection during the immediate and long-term follow-up. Results. Surgical correction of aortic arch congenital abnormalities was performed under deep hypothermic circulatory arrest in 27 patients (group I), and unilateral selective antegrade cerebral perfusion was ewmployed in 35 patients (group II). In group I, 33.3% of patients had neurologic complications, while in group II only 8.6% of patients developed such complications. The odds ratio for neurological injury was significantly lower in group II compared to group I - 0.19 (0.04-0.72), p = 0.02. Conclusions. However, renal dysfunction was significantly higher in the second group: 62.9% versus 22.2% respectively, p = 0.02. The authors conclude that aortic arch reconstruction accompanied by selective antegrade cerebral perfusion has a lower risk of neurological complications as compared with deep hypothermic circulatory arrest. However, the high incidence of renal complications with selective antegrade cerebral perfusion requires further research.