title: Complex neonatal single ventricle palliation using antegrade cerebral perfusion.
abstract: 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.
authors.affiliation: Congenital Heart Institute, Miami Children's Hospital, Miami, Florida 33155, USA. rhannan001@aol.com
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hannan
authors.forename: Marion A
authors.initials: MA
authors.lastname: Ybarra
authors.forename: Jorge W
authors.initials: JW
authors.lastname: Ojito
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Alonso
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Rossi
authors.forename: Redmond P
authors.initials: RP
authors.lastname: Burke
mesh_terms: 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