Neurodevelopmental outcomes after infant cardiac surgery with circulatory arrest and intermittent perfusion

Optimal perfusion strategies for neuroprotection during infant cardiac surgery remain undefined. Despite encouraging experimental data, neurodevelopmental (ND) outcomes after cardiac surgery in neonates and infants using deep hypothermic circulatory arrest (DHCA) with a period of intermittent perfusion have not been reported, and it is not known whether DHCA can be extended while preserving ND outcomes.

Cross-sectional ND evaluation with the Bayley Scales of Infant and Toddler Development, Third Edition was conducted at 24 months of age. Retrospective clinical data were extracted from the electronic medical record.

Forty patients underwent cardiac surgery during the first year of life using a period of uninterrupted DHCA (24 patients) or DHCA interrupted by a period of intermittent perfusion (16 patients). Total duration of DHCA ranged from 5 to 74 minutes and did not predict ND scores. Despite a longer exposure to DHCA in the intermittent perfusion group (55 minutes [1,3 interquartile [IQ] 45.3 to 65.5] versus 38 minutes [1,3 IQ 32 to 40.8]), no differences in ND scores were detected. Significant comorbidities, duration of intensive care unit and hospital stay, as well as multiple procedures with DHCA were independent predictors of ND outcomes at 24 months of age.

Despite extended duration of total DHCA, the use of a period of intermittent perfusion to limit uninterrupted DHCA periods to less than 45 minutes could lead to ND outcomes similar to those of patients exposed to brief periods of DHCA. Deep hypothermic circulatory arrest with intermittent perfusion may facilitate implementation of prospective studies to identify the optimal cerebral perfusion strategy.