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Neonatal Aortic Arch Reconstruction With Direct Splanchnic Perfusion Avoids Deep Hypothermia
Muhammad Aanish Raees1, Clinton D Morgan2, Venessa L Pinto3
1Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Children's Hospital, Nashville, Tennessee.
The Annals of Thoracic Surgery
|July 16, 2017
Summary
Neonatal aortic arch reconstruction using direct splanchnic perfusion at mild hypothermia offers improved renal protection compared to deep hypothermia. This simplified method enhances postoperative organ recovery in neonates undergoing cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Neonatal Intensive Care
Background:
- Neonatal aortic arch reconstruction traditionally relies on deep hypothermia for splanchnic organ protection.
- This approach necessitates avoiding deep hypothermia through direct in-field descending aortic perfusion.
Purpose of the Study:
- To evaluate the safety and efficacy of direct splanchnic perfusion at mild hypothermia versus deep hypothermia during neonatal aortic arch reconstruction.
- To determine if direct splanchnic perfusion improves or matches the safety of deep hypothermia and aids postoperative extracardiac organ recovery.
Main Methods:
- A cohort of 138 biventricular patients under 90 days old undergoing aortic arch reconstruction were analyzed.
- Patients were divided into two groups: Method A (deep hypothermia, 18-20°C) and Method B (mild hypothermia with splanchnic perfusion, 30-32°C).
- Perioperative clinical and serologic data were collected and analyzed for significant differences (p < 0.05).
Main Results:
- No significant differences in cardiopulmonary bypass or aortic cross-clamp times were observed between the groups.
- Method B demonstrated a significantly higher postoperative glomerular filtration rate (p=0.028-0.044) compared to Method A.
- Ventilator time, length of stay, creatinine increase, and lactate levels showed no significant differences between the perfusion methods.
Conclusions:
- Direct splanchnic perfusion during neonatal aortic arch reconstruction effectively avoids deep hypothermia.
- This simplified method provides renal protection that is at least as effective as deep hypothermia.
- The technique shows promise for improved postoperative extracardiac organ recovery in neonates.
