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Modified Technique for the Use of Neonatal Murine Hearts in the Langendorff Preparation
Published on: March 4, 2022
Complex neonatal single ventricle palliation using antegrade cerebral perfusion
Robert L Hannan1, Marion A Ybarra, Jorge W Ojito
1Congenital Heart Institute, Miami Children's Hospital, Miami, Florida 33155, USA. rhannan001@aol.com
The Annals of Thoracic Surgery
|September 26, 2006
Summary
Antegrade cerebral perfusion (ACP) significantly improves survival for usual-risk neonates undergoing single ventricle palliation. While trends suggest benefit for high-risk infants, long-term outcomes remain a concern.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Perfusion
Background:
- Efficacy of antegrade cerebral perfusion (ACP) in neonatal single ventricle palliation with arch reconstruction is unclear.
- ACP was adopted to reduce reliance on deep hypothermic circulatory arrest (DHCA).
Purpose of the Study:
- To evaluate the impact of ACP versus DHCA on survival outcomes in neonatal single ventricle palliation.
- To compare short-term and long-term survival rates between DHCA and ACP groups, stratified by risk.
Main Methods:
- Retrospective analysis of 126 neonates undergoing single ventricle palliation (1995-2004).
- Patients divided into DHCA-only (n=67) and ACP (n=59) groups.
- Risk stratification into usual and high-risk categories based on weight and comorbidities.
Main Results:
- Usual-risk neonates showed significantly higher 30-day (93.2% vs 72.0%) and 1-year (84.1% vs 57.4%) survival with ACP compared to DHCA.
- High-risk neonates demonstrated a trend towards improved survival with ACP, but not statistically significant.
- Overall survival to date was higher in the ACP group (71.2%) versus DHCA (52.2%).
Conclusions:
- ACP provides a statistically significant survival advantage for usual-risk neonates undergoing complex single ventricle palliation.
- While ACP shows a trend for improved survival in high-risk neonates, outcomes remain disappointing.
- Continued use of ACP is supported by institutional experience, contributing to an overall survival benefit.
