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Published on: December 10, 2020
[Neurological changes and outcomes of paediatric surgery of the aortic arch using selective cerebral perfusion]
Raúl Sánchez Pérez1, Pilar Tirado Requero2, Luz Polo López1
1Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España.
Insights
Children undergoing aortic arch surgery with selective cerebral perfusion (SCP) require neuropsychological follow-up. Modifiable surgical factors, like procedure duration and patient age, can influence neurological development.
Area of Science:
- Pediatric Cardiac Surgery
- Neurodevelopmental Outcomes
- Cerebral Perfusion Techniques
Background:
- Aortic arch disease in infants necessitates complex surgical interventions.
- Selective cerebral perfusion (SCP) is a critical technique during these surgeries.
- Understanding medium-term neurodevelopmental effects is crucial for patient care.
Purpose of the Study:
- To analyze medium-term neuropsychological changes in children after aortic arch surgery with SCP.
- To identify surgical technique modifications that can minimize neurological impairment.
Main Methods:
- Retrospective analysis of 82 infants operated on using SCP within their first year of life.
- Neurological assessment using the Rankin score for patients without chromosomal abnormalities.
- Intelligence, attention, and psycho-lingual skills evaluated in children over 4 years old.
Main Results:
- Overall mortality was 14.8%.
- Neurological dysfunction occurred in 35.9% of patients.
- Risk factors identified: surgery <10 days old, SCP duration >40 minutes, and temperature management times.
- Attention deficit diagnosed in 35.2% of patients >5 years old.
Conclusions:
- Neuropsychological follow-up is essential for infants undergoing aortic arch surgery with SCP.
- Certain surgical factors are modifiable and can positively impact neurological development.
Introduction:
The aims of this article are to analyse the neuropsychological changes in the medium-term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement.
Material And Methods:
Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills.
Results:
The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32ml/kg/min. The mean time of SCP was 31minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old.
Conclusions:
Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development.
