Continuous Cerebral and Myocardial Selective Perfusion in Neonatal
Aortic Arch Surgery
BACKGROUND: To assess the feasibility and outcome of Continuous Cerebral
and Myocardial Selective Perfusion (CCMSP) during aortic arch surgery in
neonates. METHODS: This retrospective single-center study was conducted
between 2008 and 2019 in neonates undergoing aortic arch surgery,
accompanied or not by cardiac malformation repair. CCMSP at moderate
hypothermic of 28°C was achieved using selective brachiocephalic artery
and ascending aorta cannulation. Target rates of cerebral and myocardial
perfusion were 25-35 mL/kg/min and 150/m2/min. Cardiopulmonary bypass
(CPB) variables and clinical outcomes were analyzed. RESULTS: Overall,
69 neonates underwent either isolated aortic arch repair (n=31) or
aortic arch repair with ventricular septal defect (VSD) closure (n=38).
The mean age and weight were 9.79±7.1 days and 3.17±0.4Kg, respectively.
Mean CPB and aortic clamping times were 133.5±47.0 and 25.2±5.3 min for
isolated aortic arch repair, and 158.4±47.9 and 75.4±30.5 min for
aortoplasty accompanied by VSD closure. Mean CCMSP time was 51.6±21.5
min with cerebral rate of 32.6±10.0mL/Kg/min. Two major complications
arose: stroke (n=1; 1.44%) and transient renal failure requiring
dialysis (n=2; 2.89%). Neither myocardial nor visceral ischemia
occurred. In-hospital mortality was 1/69 (1.44%). CONCLUSIONS: CCMSP is
a safe and reproducible strategy for cerebral, myocardial and visceral
protection in neonatal aortic arch repair, with or without VSD closure,
resulting in low complication and mortality.