Perioperative neuroprotective strategies

Area of Science:

• Pediatric Cardiology
• Neurodevelopmental Pediatrics
• Cardiothoracic Surgery

Background:

• Long-term neurodevelopmental impairment is a frequent complication in infants with congenital heart disease (CHD) undergoing surgical repair.
• The causes of this neurodevelopmental morbidity are complex, involving factors before, during, and after surgery.

Purpose of the Study:

• To review current strategies for preventing neurological injury in neonates and infants undergoing congenital heart surgery.
• To highlight the importance of perioperative neurologic monitoring and optimized perfusion techniques.

Main Methods:

• Review of recent advances in perfusion techniques during cardiopulmonary bypass.
• Discussion of cerebral monitoring methods including NIRS and transcranial Doppler.
• Analysis of factors contributing to brain injury in prenatal, intraoperative, and postoperative periods.

Main Results:

• Optimized perfusion strategies, including high-flow cardiopulmonary bypass, antegrade cerebral perfusion, and pH-stat strategy, can minimize intraoperative brain injury like periventricular leukomalacia.
• Cerebral monitoring with NIRS and transcranial Doppler aids in preventing adverse neurologic events.
• Brain injury can also occur prenatally and postoperatively, necessitating further investigation.

Conclusions:

• Current perfusion and monitoring techniques can significantly reduce intraoperative brain injury in CHD surgery.
• Improved strategies are needed to address prenatal, preoperative, and postoperative factors contributing to neurodevelopmental impairment.
• Further clinical research is essential to optimize neuroprotection and long-term outcomes for children with CHD.