期刊
ARTIFICIAL ORGANS
卷 43, 期 8, 页码 728-735出版社
WILEY
DOI: 10.1111/aor.13430
关键词
aortic arch hypoplasia; aortic arch surgery; cerebral perfusion; coarctation; interrupted aortic arch; myocardial perfusion; neonate
资金
- British Heart Foundation [CH/17/1/32804, PG/15/33/31394] Funding Source: Medline
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 perfusion, using a single pump rotor with an arterial line Y-connector. Between May 2008 and May 2016, 69 consecutive neonates underwent arch repair using either selective cerebro-myocardial perfusion (Group A, n=34) or standard perfusion (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. The duration of the 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), the duration of myocardial ischemia was longer in Group A (64 +/- 41 vs. 44 +/- 14 min, P=0.04). 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 extracardiac morbidity was similar in both the groups. During follow-up (3.2 +/- 2.4 years), 5 late deaths occurred with a comparable 5-year survival rate (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, CI 1.87-5.95, P=0.04). Cerebro-myocardial perfusion is a safe and effective strategy to protect the brain and heart in neonates undergoing arch repair. Selective techniques using higher perfusion flows may further attenuate cardiac morbidity.
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