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

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.