Selective Versus Standard Cerebro-Myocardial Perfusion in Neonates Undergoing Aortic Arch Repair: A Multi-Center Study.

BACKGROUND: The results of neonatal aortic arch surgery using cerebro-myocardial perfusion were analyzed. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard, using a single pump rotor with an arterial line Y-connector.

METHODS: Between 5/2008-5/2016, 69 consecutive neonates underwent arch repair using either selective cerebro-myocardial perfusion (Group A, n=34) or standard (Group B, n=35). The groups were similar for age, weight, BSA, prevalence of one-stage or staged repair and single ventricle palliation; male gender was more frequent in Group A. Duration of cerebro-myocardial perfusion was comparable (27±8 vs. 28±7 min., p=0.9), with higher flows in Group A (57±27 vs. 39±19 mL/kg/min, p=0.01). Although cardioplegic arrest was more common in Group B (13/34 vs. 23/35, p=0.03), duration of myocardial ischemia was longer in Group A (64±41 vs. 44±14 min, p=0.04).

RESULTS: There was 1 hospital death in each group, with no permanent neurological injury in either group. Cardiac morbidity (1/34 vs. 7/35, p=0.02) was more common in Group B, while extra-cardiac morbidity was similar. During follow-up (3.2±2.4 years), 5 late deaths occurred with comparable 5-year survival (75±17% vs. 88±6%, p=0.7) and freedom from arch reintervention (86±6% vs. 84±7%, p=0.6). Risk of cardiac morbidity was greater with standard cerebro-myocardial perfusion (OR=5.2, CI 3.3-6.8, p=0.001) and with perfusion flows less than 50 ml/kg/min (OR 3.7, Cl 1.87-5.95, p=0.04).

CONCLUSIONS: Cerebro-myocardial perfusion is a safe and effective strategy to protect brain and heart in neonates undergoing arch repair. Selective technique using higher perfusion flows may further attenuate cardiac morbidity. This article is protected by copyright. All rights reserved.