title: Neurological injury after neonatal cardiac surgery: a randomized, controlled trial of 2 perfusion techniques.
abstract: BACKGROUND
  Complex neonatal cardiac surgery is associated with cerebral injury. In particular, aortic arch repair, requiring either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP), entails a high risk of perioperative injury. It is unknown whether ACP results in less cerebral injury than DHCA.
  
  
  RESULTS
  Thirty-seven neonates with an aortic arch obstruction presenting for univentricular or biventricular repair were randomized to either DHCA or ACP. Preoperatively and 1 week after surgery, magnetic resonance imaging was performed in 36 patients (1 patient died during the hospital stay). The presence of new postoperative cerebral injury was scored, and results were entered into a sequential analysis, which allows for immediate data analysis. After the 36th patient, it was clear that there was no difference between DHCA and ACP in terms of new cerebral injury. Preoperatively, 50% of patients had evidence of cerebral injury. Postoperatively, 14 of 18 DHCA patients (78%) had new injury versus 13 of 18 ACP patients (72%) (P=0.66). White matter injury was the most common type of injury in both groups, but central infarctions occurred exclusively after ACP (0 vs. 6/18 [33%]; P=0.02). Early motor and cognitive outcomes at 24 months were assessed and were similar between groups (P=0.28 and P=0.25, respectively). Additional analysis revealed lower postoperative arterial Pco2 as a risk factor for new white matter injury (P=0.04).
  
  
  CONCLUSIONS
  In this group of neonates undergoing complex cardiac surgery, we were unable to demonstrate a difference in the incidence of perioperative cerebral injury after ACP compared with DHCA. Both techniques resulted in a high incidence of new white matter injury, with central infarctions occurring exclusively after ACP.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01032876.
authors.affiliation: Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.).
authors.forename: Selma O
authors.initials: SO
authors.lastname: Algra
authors.forename: Nicolaas J G
authors.initials: NJ
authors.lastname: Jansen
authors.forename: Ingeborg
authors.initials: I
authors.lastname: van der Tweel
authors.forename: Antonius N J
authors.initials: AN
authors.lastname: Schouten
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Mona
authors.initials: M
authors.lastname: Toet
authors.forename: Wim
authors.initials: W
authors.lastname: van Oeveren
authors.forename: Ingrid C
authors.initials: IC
authors.lastname: van Haastert
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schoof
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
authors.forename: Felix
authors.initials: F
authors.lastname: Haas
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D003071:Cognition / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity / Q000502:physiology; D010477:Perfusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: brain ischemia; cardiopulmonary bypass; pediatrics