Comparable lung injury with and without distal perfusion during aortic arch procedure in piglets

The reduction of pulmonary impairment due to complex aortic arch procedures in neonates and infants requires the most protective perfusion strategy during surgical intervention. We compared the selective anterograde cerebral perfusion (SACP) and SACP plus distal perfusion (SACP + DP) with moderate hypothermia in a piglet model with a focus on lung injury.

Suckling piglets (2.5-10 kg) were randomized to undergo cross clamp for 60 min with either SACP (n = 9) or SACP + DP (n = 9) followed by 120 min of recovery. Lung tissue biopsies were analyzed for histological changes and the induction of hypoxia-related and pro-apoptotic factors.

Differences in body perfusion were proven by increased blood lactate levels (p = 0.01) and decreased oxygen saturation (p = 0.01) with SACP group compared to SACP + DP. The numbers of alveolar macrophages and type II pneumocytes (p = 0.39) as well as neutrophil profiles per area (p = 0.33) were similar in the SACP and SACP + DP group after 120 min of recovery. Stereological parameters of blood-air barrier damage and edema development were not different between both groups. Oxidative stress and the mitochondrial release of the pro-apoptotic molecules were similar in the SACP and the SACP + DP group.

Our piglet study demonstrated a similar degree of lung injury in SACP and SACP + DP during aortic arch procedures.

SACP and SACP + DP during aortic arch surgery lead to a similar degree of lung injury in a piglet model. This prospective randomized comparison including histopathological and stereological analyses provides an objective evaluation of lung injury with different perfusion strategies. Clinical decision making for an optimal perfusion strategy in pediatric patients could be supported by the results of this study.