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Goal-directed-perfusion in neonatal aortic arch surgery
Robert Anton Cesnjevar1, Ariawan Purbojo1, Frank Muench1
1Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Erlangen, Germany.
Translational Pediatrics
|October 7, 2016
Summary
Improving congenital cardiac surgery outcomes requires careful management of aortic arch procedures in neonates. Different perfusion strategies like deep hypothermic circulatory arrest and regional cerebral perfusion carry risks, necessitating vigilant monitoring of organ perfusion.
Area of Science:
- Congenital Cardiac Surgery
- Neonatal Aortic Arch Repair
- Cardiopulmonary Bypass Techniques
Background:
- Minimizing mortality and morbidity in congenital cardiac surgery is a primary goal.
- While surgical techniques advance, risks and complications persist, particularly in neonatal aortic arch surgery.
- Diverse perfusion strategies are employed, lacking a universally accepted 'total body perfusion' (TBP) standard.
Approach:
- Comparison of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP), and TBP.
- Analysis of organ damage risks associated with varying perfusion management, core temperatures, and bypass durations.
- Emphasis on end-organ perfusion monitoring for patient safety during cardiopulmonary bypass.
Key Points:
- Aortic arch surgery in neonates presents unique perfusion challenges.
- DHCA, RCP, and TBP each have distinct associated risks for organ injury.
- Adequate tissue protection, temperature control, and oxygen delivery are critical.
Conclusions:
- Optimizing perfusion strategies is essential for reducing complications in neonatal aortic arch surgery.
- Continuous monitoring of end-organ perfusion (brain, heart, kidney, liver, gut) is vital for patient safety.
- Further research into standardized and effective perfusion techniques is warranted.
