title: Goal-directed-perfusion in neonatal aortic arch surgery.
abstract: Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve. Thus concepts of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP/with cardioplegic cardiac arrest or on the perfused beating heart) and TBP exist in parallel and all carry an individual risk for organ damage related to perfusion management, chosen core temperature and time on bypass. Patient safety relies more and more on adequate end organ perfusion on cardiopulmonary bypass, especially sensitive organs like the brain, heart, kidney, liver and the gut, whereby on adequate tissue protection, temperature management and oxygen delivery should be visualized and monitored.
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Robert Anton
authors.initials: RA
authors.lastname: Cesnjevar
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Muench
authors.affiliation: Department of Pediatrics, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Juengert
authors.affiliation: Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Rueffer
keywords: Congenital heart disease; neonatal arch surgery; organ protection; regional cerebral perfusion (RCP)