MHCA with SACP versus DHCA in Pediatric Aortic Arch Surgery: A Comparative Study

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiac Surgery
• Cerebral Perfusion Techniques

Background:

• The safety and efficacy of selective antegrade cerebral perfusion (SACP) in pediatric aortic arch surgery remain incompletely understood.
• Current practices often involve deep hypothermic circulatory arrest (DHCA), with potential for significant complications.

Purpose of the Study:

• To compare the outcomes of moderate hypothermic circulatory arrest (MHCA) with SACP versus DHCA in children undergoing aortic arch surgery.
• To evaluate the impact of SACP on neurologic complications, organ system complications, and short-term postoperative recovery.

Main Methods:

• Retrospective analysis of pediatric patients undergoing aortic arch surgery between January 2008 and December 2017.
• Comparison of two groups: MHCA + SACP (n=61) and DHCA (n=53).
• Analysis of demographic data, surgical variables, and postoperative outcomes, including complications and length of stay.

Main Results:

• The MHCA + SACP group demonstrated significantly shorter cardiopulmonary bypass (CPB) times and higher nasopharyngeal temperatures.
• Lower rates of neurologic complications were observed in the MHCA + SACP group (3/61 vs 10/53).
• Patients in the MHCA + SACP group experienced reduced 24-hour chest drainage, shorter mechanical ventilation duration, and decreased intensive care unit (ICU) stay.

Conclusions:

• Moderate hypothermic circulatory arrest (MHCA) combined with selective antegrade cerebral perfusion (SACP) is associated with improved short-term outcomes in pediatric aortic arch surgery.
• Longer CPB time was identified as a risk factor for in-hospital mortality.
• MHCA + SACP offers a potentially safer and more effective alternative to DHCA for this patient population.