title: Variation in Perfusion Strategies for Neonatal and Infant Aortic Arch Repair: Contemporary Practice in the STS Congenital Heart Surgery Database.
abstract: BACKGROUND
  Regional cerebral perfusion (RCP) is used as an adjunct or alternative to deep hypothermic circulatory arrest (DHCA) for neonates and infants undergoing aortic arch repair. Clinical studies have not demonstrated clear superiority of either strategy, and multicenter data regarding current use of these strategies are lacking. We sought to describe the variability in contemporary practice patterns for use of these techniques.
  
  
  METHODS
  The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2013) was queried to identify neonates and infants whose index operation involved aortic arch repair with cardiopulmonary bypass. Perfusion strategy was classified as isolated DHCA, RCP (with less than or equal to ten minutes of DHCA), or mixed (RCP with more than ten minutes of DHCA). Data were analyzed for the entire cohort and stratified by operation subgroups.
  
  
  RESULTS
  Overall, 4,523 patients (105 centers) were identified; median age seven days (interquartile range: 5.0-13.0). The most prevalent perfusion strategy was RCP (43%). Deep hypothermic circulatory arrest and mixed perfusion accounted for 32% and 16% of cases, respectively. In all, 59% of operations involved some period of RCP. Regional cerebral perfusion was the most prevalent perfusion strategy for each operation subgroup. Neither age nor weight was associated with perfusion strategy, but reoperations were less likely to use RCP (31% vs 45%, P < .001). The combined duration of RCP and DHCA in the RCP group was longer than the DHCA time in the DHCA group (45 vs 36 minutes, P < .001).
  
  
  CONCLUSIONS
  There is considerable variability in practice regarding perfusion strategies for arch repair in neonates and infants. In contemporary practice, RCP is the most prevalent perfusion strategy for these procedures. Use of DHCA is also common. Further investigation is warranted to ascertain possible relative merits of the various perfusion techniques.
authors: Division of Cardiothoracic Surgery, Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY, USA dmeyer@northwell.edu.
authors: David B
authors: DB
authors: Meyer
authors: Division of Cardiac Surgery, Johns Hopkins All Children's Heart Institute, All Children's and Florida Hospital for Children, Johns Hopkins School of Medicine, St Petersburg, FL, USA.
authors: Jeffrey P
authors: JP
authors: Jacobs
authors: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors: Kevin
authors: K
authors: Hill
authors: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors: Amelia S
authors: AS
authors: Wallace
authors: Division of Surgery, Children's Hospital of Georgia, Medical College of Georgia, Augusta, GA, USA.
authors: Brian
authors: B
authors: Bateson
authors: Division of Cardiac Surgery, Johns Hopkins All Children's Heart Institute, All Children's and Florida Hospital for Children, Johns Hopkins School of Medicine, St Petersburg, FL, USA.
authors: Marshall L
authors: ML
authors: Jacobs
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010477:Perfusion / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: aorta/aortic; aortic arch; database; pediatric; perfusion