Moderately hypothermic cardiopulmonary bypass and low-flow antegrade selective cerebral perfusion for neonatal aortic arch surgery.
BACKGROUND
Although deep hypothermic circulatory arrest has been extensively used in neonates for aortic arch surgery, the brain and other organs might be adversely affected by prolonged ischemia and deep hypothermia.


METHODS
Between December 1997 and January 2005, 70 consecutive neonates underwent Norwood stage I procedure for hypoplastic left heart syndrome (group A, n = 30), or aortic arch repair for interruption or coarctation with arch hypoplasia (group B, n = 40), with antegrade selective cerebral perfusion (ASCP). Mean weights were 3.0 +/- 0.2 kg and 2.8 +/- 0.07 kg, and mean ages were 10 +/- 3.5 days and 14 +/- 10.6 days in groups A and B, respectively. Only 2 patients were older than 30 days. Core body temperature was lowered to 25 degrees C, and mean pump flow during ASCP was initiated at 10 to 20 mL/(kg x min) and adjusted to guarantee a radial/temporal artery pressure of 30 to 40 mm Hg and venous oxygen saturation of more than 70%. Hematocrit was maintained at 30%.


RESULTS
Early mortality was 17% (group A, 23%; group B, 12.5%; p = 0.19). Six late deaths occurred (3 in each group), and at 36 months, Kaplan-Meier overall survival was 64% +/- 9.2% in group A and 85% +/- 5.7% in group B. One patient had postoperative seizures. Age, weight, sex, prematurity, group A, and ASCP duration did not influence early mortality.


CONCLUSIONS
Antegrade selective cerebral perfusion is a safe and effective procedure and might improve outcome of neonatal aortic arch surgery, minimizing neurologic impact without the need for deep hypothermia.
Oppido
Guido
G
Pediatric Cardiac Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy. guidooppido@yahoo.com
Pace Napoleone
Carlo
C
Turci
Simone
S
Davies
Ben
B
Frascaroli
Guido
G
Martin-Suarez
Sofia
S
Giardini
Alessandro
A
Gargiulo
Gaetano
G
D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000401:mortality*; D002560:Cerebrovascular Circulation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010477:Perfusion / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome