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Comparable Cerebral Blood Flow in Both Hemispheres During Regional Cerebral Perfusion in Infant Aortic Arch Surgery
André Rüffer1, Philip Tischer1, Frank Münch1
1Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Insights
Regional cerebral perfusion (RCP) during aortic arch repair provides adequate bilateral cerebral blood flow. This method ensures near-symmetric blood flow to both hemispheres, supporting neuroprotection in infants.
Area of Science:
- Pediatric Cardiac Surgery
- Cerebrovascular Physiology
- Medical Imaging
Background:
- Aortic arch repair necessitates cerebral protection.
- Regional cerebral perfusion (RCP) via the innominate artery is a key protective strategy.
- Ensuring adequate bilateral cerebral blood flow during RCP is critical.
Purpose of the Study:
- To evaluate the adequacy of bilateral cerebral blood flow during RCP.
- To compare cerebral blood flow dynamics between RCP and total body perfusion (TBP).
Main Methods:
- Prospective study of 14 infants undergoing RCP.
- Utilized combined transfontanellar/transtemporal Doppler sonography to assess cerebral blood flow.
- Measured time-average velocities in major cerebral arteries and regional cerebral oxygenation (rSO2).
- Compared measurements during RCP and TBP at target temperature (28°C).
Main Results:
- Visualized near-symmetric blood flow intensity to both hemispheres during RCP and TBP.
- Observed retrograde flow in the left internal carotid artery during RCP.
- Found comparable cerebral time-average velocities and rSO2 between hemispheres, with a trend towards higher velocities on the right.
- Noted significantly higher rSO2 in the right hemisphere during TBP compared to RCP.
Conclusions:
- Regional cerebral perfusion (RCP) demonstrates near-symmetric blood flow distribution to both cerebral hemispheres.
- Cerebral blood flow intensity and oxygenation appear adequate with RCP.
- Further neurodevelopmental studies are required to confirm RCP's neuroprotective efficacy in aortic arch repair.
Background:
Cerebral protection during aortic arch repair can be provided by regional cerebral perfusion (RCP) through the innominate artery. This study addresses the question of an adequate bilateral blood flow in both hemispheres during RCP.
Methods:
Fourteen infants (median age 11 days [range, 3 to 108]; median weight, 3.6 kg [range, 2.8 to 6.0 kg]) undergoing RCP (flow rate 54 to 60 mL · kg-1 · min-1) were prospectively included. Using combined transfontanellar/transtemporal two- and three-dimensional power/color Doppler sonography, cerebral blood flow intensity in the main cerebral vessels was displayed. Mean time average velocities were measured with combined pulse-wave Doppler in the basilar artery, and both sides of the internal carotid, anterior, and medial cerebral arteries. In addition, bifrontal regional cerebral oximetry (rSO2) was assessed. Comparing both hemispheres, measurements were performed at target temperature (28°C) during full-flow total body perfusion (TBP) and RCP.
Results:
A regular circle of Willis with near-symmetric blood flow intensity to both hemispheres was visualized in all infants during both RCP and TBP. In the left internal carotid artery, blood flow direction was mixed (retrograde, n = 5; antegrade, n = 8) during TBP and retrograde during RCP. Comparison between sides showed comparable cerebral time average velocities and rSO2, except for higher time average velocities in the right internal carotid artery (TBP p = 0.019, RCP p = 0.09). Unilateral comparison between perfusion methods revealed significantly higher rSO2 in the right hemisphere during TBP (82% ± 9%) compared with RCP (74% ± 11%, p = 0.036).
Conclusions:
Bilateral assessment of cerebral rSO2 and time average velocity in the main great cerebral vessels suggests that RCP is associated with near-symmetric blood flow intensity to both hemispheres. Further neurodevelopmental studies are necessary to verify RCP for neuroprotection during aortic arch repair.
