Selective visceral perfusion improves renal flow and hepatic function in neonatal aortic arch repair.

Abstract

The aortic arch repair in the neonatal period is a complex procedure with significant morbidity. We define a useful double-perfusion technique and its effect on the function of abdominal organs in the postoperative course. Nine patients with double perfusion (Group 1) were compared with 14 patients with antegrade cerebral perfusion (Group 2). The objective was to discern the incidence of postoperative acute kidney injury and impaired hepatic function, as well as tissue perfusion and myocardial function parameters. Mechanical ventilation time, postoperative length of stay and 30-day mortality were measured. We excluded patients with extracorporeal membrane oxygenation, early mortality (<72 h) and preoperative renal or hepatic insufficiency. Nine (39%) patients developed postoperative acute kidney injury, with 22% (n = 2) in Group 1 and 50% (n = 7) in Group 2 (P = 0.183). A higher urine output was observed during the first 24 h for Group 1 (P = 0.032). Eleven patients developed impaired hepatic function in the immediate postoperative period: 2 (18.2%) in Group 1 and 9 (81.8%) in Group 2 (P = 0.04). The international normalized ratio (P = 0.006-0.031) and prothrombin time (P = 0.007-P = 0.016) were significantly lower in the double-perfusion group during the first 72 h. Significant difference was observed in lactate levels in the first 72 h (P = 0.001-0.009). There was no postoperative mortality in either group. Selective visceral perfusion is a safe procedure that provides a better urine output, hepatic function and tissue perfusion. This technique allows for the repair of complex aortic arch anomalies in neonates without deep hypothermic circulatory arrest.