Newborn aortic arch reconstruction with descending aortic cannulation improves postoperative renal function

Area of Science:

• Cardiovascular Surgery
• Neonatal Medicine
• Perfusion Techniques

Background:

• A shift in perfusion strategy for neonatal aortic arch reconstruction occurred, moving from selective cerebral perfusion with deep hypothermic circulatory arrest to dual arterial cannulation (DAC) with continuous mild hypothermia.
• This retrospective study compares outcomes between the two perfusion techniques in neonates undergoing aortic arch reconstruction.

Purpose of the Study:

• To compare the clinical outcomes of neonatal aortic arch reconstruction using dual arterial cannulation (DAC) versus selective cerebral perfusion.
• To evaluate the impact of these perfusion techniques on renal function and other perioperative parameters.

Main Methods:

• Retrospective review of 142 neonates undergoing aortic arch reconstruction between April 2004 and September 2012.
• Renal function assessed using the pediatric RIFLE score; patients requiring extracorporeal membrane oxygenation were excluded from renal analysis.
• Multivariable regression models identified predictors of pediatric RIFLE score.

Main Results:

• The DAC group experienced shorter bypass (113 vs. 172 min) and myocardial ischemic times (43 vs. 81 min) compared to selective cerebral perfusion (p < 0.001 for both).
• Patients with DAC had significantly less fluid gain at 24 hours (37 vs. 69 mL/kg; p < 0.001) and a lower incidence of acute kidney injury (5% vs. 31%; p < 0.001).
• Fewer patients in the DAC group required an open chest (31% vs. 58%; p = 0.001).

Conclusions:

• Multisite arterial perfusion, including DAC with continuous mild hypothermic cardiopulmonary bypass, may be advantageous for neonatal aortic arch reconstruction.
• The findings suggest potential benefits in terms of reduced organ injury and shorter support times.
• Further prospective studies are warranted to confirm the advantages of this perfusion strategy.