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Published on: December 10, 2020
Regional cerebral perfusion for surgical correction of neonatal aortic arch obstruction
Hui Zhang1, Pei Cheng, Jia Hou
1Department of Pediatric Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
One-stage repair of aortic arch anomalies in infants using regional cerebral perfusion (RCP) shows excellent outcomes. This surgical approach minimizes neurologic and renal complications, with all patients developing normally post-operation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Vascular Reconstruction
Background:
- Aortic arch obstruction and associated cardiac anomalies present significant surgical challenges in infants.
- One-stage repair is often preferred but requires meticulous technique to ensure optimal outcomes.
Purpose of the Study:
- To review the outcomes of one-stage surgical correction for interrupted aortic arch (IAA), isolated aortic coarctation (iCoA), and coarctation with hypoplastic aortic arch (CoA-HyAA).
- To evaluate the efficacy of regional cerebral perfusion (RCP) in minimizing complications during these complex infant surgeries.
Main Methods:
- A retrospective review of 24 infant patients undergoing one-stage aortic arch repair between January 2007 and July 2008.
- All patients received regional cerebral perfusion (RCP) at 40 mL/kg/min through the innominate artery during aortic arch reconstruction.
- Various surgical techniques including end-to-end anastomosis, extended anastomosis, and composite pericardial patch were employed based on the anomaly.
Main Results:
- Operative mortality was 8.3% (2 out of 24 patients).
- Mean follow-up was 10.5 months with no late mortality or postoperative neurologic, renal, or hepatic complications.
- All surviving patients were asymptomatic and developing normally, with a low rate of residual or recurrent coarctation.
Conclusions:
- One-stage total arch repair utilizing the regional cerebral perfusion (RCP) technique is an effective strategy for infant aortic arch anomalies.
- This approach is associated with excellent clinical outcomes and a reduced incidence of neurologic and renal complications.
- The described surgical strategy demonstrates a low rate of residual and recurrent coarctation in this pediatric population.
Abstract:
One-stage repair of aortic arch obstruction and associated cardiac anomalies is a surgical challenge in infants.The purpose of the present study is to review the current outcome using regional cerebral perfusion (RCP) during a procedure correcting interrupted aortic arch (IAA) and also isolated aortic coarctation (CoA) and CoA combined with hypoplastic aortic arch (CoA-HyAA) in our center. Between January 2007 and July 2008, 24 infant patients with interrupted aortic arch (IAA) (n=3), isolated aortic coarctation (iCoA) (n=9) and aortic coarctation with hypoplastic aortic arch (CoA-HyAA) (n=12) underwent one-stage surgical correction in our hospital. End-to-end anastomosis was employed in 12 infants (IAA n=3 and iCoA n=9); for the other 12 patients with CoA-HyAA, an end-to-end extended anastomosis was used in 8 cases, end-to-side anastomosis in 2 cases, and composite heterologous pericardial patch in 2 cases. RCP with 40 mL/kg/min through the innominate artery during aortic arch reconstruction was employed for all pediatric patients. One single-dose histidine-ketoglutarate-tryptophan (HTK) solution was used for myocardial protection during CPB. Cardiopulmonary bypass time and aortic cross-clamp time were 165.6+/-32.4 min and 81.7+/-30.0 min, respectively. The mean regional cerebral perfusion time was 31.0+/-10.6 min; lowest nasopharyngeal temperature was 19.1+/-1.1 degrees C. Operative mortality rate in both groups was 8.3%. Mean follow-up was 10.5+/-4.8 months. There was no late mortality or postoperative neurologic, renal or hepatic complications. All patients are asymptomatic and are developing normally. One-stage total arch repair using the RCP technique is an excellent method that may minimize neurologic and renal complications. Our surgical strategy for arch anomaly has a low rate of residual and recurrent coarctation when performed in these infants.