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Usefulness of Deep Hypothermic Circulatory Arrest and Regional Cerebral Perfusion in Children
Zheng Guo1, Ren-Jie Hu, De-Ming Zhu
1Department of Pediatric Thoracic and cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, People's Republic of China .
Insights
Regional cerebral perfusion (RCP) offers better neurological protection than deep hypothermic circulatory arrest (DHCA) in pediatric open-heart surgery. This study found RCP associated with fewer neurological dysfunctions, making it a reliable technique for complex congenital heart defect repairs.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Neurological Protection
Background:
- Deep hypothermic circulatory arrest (DHCA) and regional cerebral perfusion (RCP) are techniques used in pediatric open-heart surgery.
- Comparing the safety and efficacy of these methods is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the safety and effectiveness of DHCA and RCP in pediatric open-heart surgery.
- To evaluate neurological dysfunction rates and other complications between the two techniques.
Main Methods:
- A retrospective study of 1250 children with congenital cardiac defects undergoing open-heart surgery.
- Patients were divided into DHCA (947 cases) and RCP (303 cases) groups.
- Data collected included mortality rates, neurological dysfunction, and other postoperative complications.
Main Results:
- Mortality rates were similar between DHCA (7.18%) and RCP (6.60%) groups.
- Postoperative neurological dysfunction was significantly lower in the RCP group (2.64%) compared to the DHCA group (6.23%) (p<0.01).
- Incidences of other complications like low cardiac output, renal, and lung issues were comparable between groups.
Conclusions:
- Regional cerebral perfusion (RCP) is a reliable technique for cerebral protection during pediatric open-heart surgery.
- RCP facilitates complex congenital cardiac defect repairs by allowing more time for procedures.
- RCP demonstrates a lower incidence of neurological dysfunction compared to DHCA.
Abstract:
To compare the safety and usefulness of deep hypothermic circulatory arrest (DHCA) and regional cerebral perfusion (RCP) during pediatric open heart surgery. Between January 1, 2004 and September 30, 2012, 1250 children with congenital cardiac defect underwent corrective operation with the DHCA or RCP technique in the Shanghai Children's Medical Center. Of them, 947 cases underwent the operation with the aid of DHCA (DHCA group), and 303 cases with RCP (RCP group). The mean DHCA time was 30.64±15.81 (7-63) minutes and mean RCP time was 36.18±12.86 (10-82) minutes. The mortality rate was 7.18% (68/947) and 6.60% (20/30) in two groups, respectively. The postoperative incidences of temporary and permanent neurological dysfunction were 6.23% (59/947) in the DHCA group and 2.64% (8/303) in the RCP group (p<0.01). The incidence of other complications such as low cardiac output, renal dysfunction, and lung issues are similar in both groups. RCP is a reliable technique for cerebral protection and it facilitates time-consuming corrected procedures for complex congenital cardiac defect repair procedures.
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