Complex neonatal single ventricle palliation using antegrade cerebral perfusion.
BACKGROUND
The efficacy of antegrade cerebral perfusion (ACP) during complex neonatal single ventricle palliation requiring arch reconstruction is uncertain. We adapted the use of ACP in early 2001 in a programmatic effort to minimize the use of deep hypothermic circulatory arrest (DHCA).


METHODS
We retrospectively analyzed data of 126 consecutive patients operated on between 1995 and 2004, including stage-one palliation of hypoplastic left heart syndrome, stage-one palliation for nonhypoplastic left heart syndrome, and Damus-Kaye-Stansel procedures. Patients were divided into two groups: those repaired with prolonged DHCA only (n = 67) and those with ACP (n = 59) and usually a shorter period of DHCA. Risk was further stratified into high risk (weight < or = 2.5 kg or other cardiac lesion) and usual risk for each group.


RESULTS
Survival at 30 days in the usual-risk groups was 72.0% DHCA and 93.2% ACP (p < or = 0.025), and in the high-risk groups it was 61.5% DHCA and 80% ACP (not significant). One-year survival in the usual-risk groups was 57.4% DHCA and 84.1% ACP (p < or = 0.01), and in the high-risk groups it was 38.5% DHCA and 46.7% ACP (not significant). Overall survival to date is 52.2% DHCA and 71.2% ACP (p < or = 0.5).


CONCLUSIONS
There is a statistically significant survival advantage for usual-risk patients with the use of ACP. Although there is a trend to improved survival in the high-risk groups, it does not reach statistical significance and long-term outcomes in these patients remains disappointing. We continue to use ACP and believe it contributes to an overall survival advantage in our institution.
Hannan
Robert L
RL
Congenital Heart Institute, Miami Children's Hospital, Miami, Florida 33155, USA. rhannan001@aol.com
Ybarra
Marion A
MA
Ojito
Jorge W
JW
Alonso
Francisco A
FA
Rossi
Anthony F
AF
Burke
Redmond P
RP
D001013:Aorta, Thoracic / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D010477:Perfusion; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome