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Standardized Beating-Heart Aortic Arch Reconstruction with Simultaneous Cerebral and Coronary Perfusion in Neonates
Shiraslan Bakhshaliyev1,2, Ergin Arslanoglu1
1Pediatric Cardiovascular Surgery Department, Atlas University Hospital, Istanbul 34203, Turkey.
Insights
This study shows a standardized beating-heart aortic arch reconstruction with simultaneous cerebral and coronary perfusion offers good early outcomes for infants. The strategy improved hemodynamic stability and postoperative recovery in complex cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Neonatal Intensive Care
Background:
- Neonatal and infant aortic arch reconstruction is a high-risk procedure.
- Effective cerebral and myocardial protection are crucial.
- Perfusion strategies impact hemodynamic stability and recovery.
Purpose of the Study:
- Evaluate early and short-term cardiovascular outcomes.
- Assess a standardized beating-heart aortic arch reconstruction strategy.
- Incorporate simultaneous antegrade selective cerebral and continuous coronary perfusion.
Main Methods:
- Retrospective single-center cohort study of 31 neonates and infants.
- Standardized protocol: ductal resection, anastomosis, pericardial patch, moderate hypothermia.
- Antegrade selective cerebral perfusion and continuous coronary perfusion via innominate artery cannulation.
Main Results:
- No in-hospital mortality; infrequent major complications.
- Median ICU stay of 5 days.
- One reintervention for recoarctation at 6.8 months median follow-up; no late mortality.
Conclusions:
- Standardized beating-heart strategy with dual perfusion shows favorable outcomes.
- Continuous coronary perfusion may enhance myocardial stability and recovery.
- Observational findings require larger studies for confirmation.
Background:
Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion.
Methods:
In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed.
Results:
The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed.
Conclusions:
A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings.
