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Continuous Cerebral and Myocardial Selective Perfusion in Neonatal Aortic Arch Surgery
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  • Pierre Maminirina,
  • Carine Pavy,
  • Pierre Bourgoin,
  • Olivier Baron
Pierre Maminirina
University Hospital Centre Nantes
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Carine Pavy
University Hospital Centre Nantes
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Pierre Bourgoin
University Hospital Centre Nantes
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Olivier Baron
University Hospital Centre Nantes
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Peer review status:IN REVISION

07 May 2020Submitted to Journal of Cardiac Surgery
16 May 2020Submission Checks Completed
16 May 2020Assigned to Editor
16 May 2020Reviewer(s) Assigned
18 May 2020Review(s) Completed, Editorial Evaluation Pending
18 May 2020Editorial Decision: Revise Minor
17 Jun 20201st Revision Received
20 Jun 2020Submission Checks Completed
20 Jun 2020Assigned to Editor
20 Jun 2020Reviewer(s) Assigned
25 Jun 2020Review(s) Completed, Editorial Evaluation Pending
25 Jun 2020Editorial Decision: Revise Minor

Abstract

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.