Bihemispheric antegrade cerebral perfusion during aortic arch reconstruction

Background: Aortic arch reconstruction is often challenging, especially in infants, owing to its high postoperative complication risks. This study aimed to compare the effectiveness between selective antegrade cerebral perfusion (SACP) alone and SACP in combination with continuous lower body perfusion with descending aortic cannulation (DAC) in preserving renal function, and to determine the influence of perfusion strategy on the postoperative course of infants who underwent aortic arch reconstruction. Material and Methods: A total of 121 infants who underwent aortic arch reconstruction between January 2008 and December 2018 were included in the analysis. Patients (median age: 29 days, range: 3-270 days) were divided into the following groups: those who underwent repair with SACP (SACP group, 79 patients) and those who underwent additional lower body perfusion (DAC group, 42 patients). Results: Three (7.1%) and nine (11.4%) patients died in the DAC and SACP groups, respectively ( P = .54). The SACP group had more patients requiring renal replacement therapy ( P = .002) and higher incidence of second stage acute kidney injury (AKI) development (Kidney disease improving global outcomes (KDIGO) criteria; P = .032). The SACP group had higher frequency of open chest postoperatively than the DAC group ( P = .011). The DAC group had lower vasoactive inotropic score (VIS) at the first postoperative day ( P < .001) and shorter intensive care unit length of stay ( P = .050). There was no difference in neurological complications between the groups ( P = .061). High VIS was associated with early mortality (odds ratio [OR]: 1.79 [1.33-2.41], P < .001) and AKI (OR: 1.60 [1.35-1.91], P < .001). The DAC perfusion strategy with minimal hypothermia was associated with lower risk of AKI (OR: 0.91 [0.84-0.98], P = .016). Conclusion: Antegrade cerebral perfusion with continuous lower body perfusion via DAC could effectively be used for improving early postoperative results among infants undergoing procedures that include aortic arch reconstruction.

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Low-flow antegrade cerebral perfusion attenuates early renal and intestinal injury during neonatal aortic arch reconstruction

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.03.008 ◽

2012 ◽

Vol 144 (6) ◽

pp. 1323-1328.e2 ◽

Cited By ~ 22

Author(s):

Selma O. Algra ◽

Antonius N.J. Schouten ◽

Wim van Oeveren ◽

Ingeborg van der Tweel ◽

Paul H. Schoof ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Intestinal Injury ◽

Low Flow ◽

Aortic Arch Reconstruction ◽

Arch Reconstruction ◽

Antegrade Cerebral Perfusion

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Assessment of children`s psychomotor development in the remote period after aortic arch reconstruction with antegrade cerebral perfusion

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2021.1-2.33 ◽

2021 ◽

Vol 88 (1-2) ◽

pp. 33-38

Author(s):

Y. P. Truba ◽

L. M. Tkachenko ◽

R. I. Sekelyk ◽

I. V. Dzyurii ◽

V. V. Lazoryshynets

Keyword(s):

Aortic Arch ◽

Motor Development ◽

Cerebral Perfusion ◽

Postoperative Mortality ◽

Psychomotor Development ◽

Significant Difference ◽

Aortic Arch Reconstruction ◽

Arch Reconstruction ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Objective. To evaluate the psychomotor development of children after aortic arch reconstruction in the conditions of selective antegrade cerebral perfusion. Materials and methods. The results of surgical treatment and psychomotor development of 48 children aged 1 to 3 years, who underwent reconstruction of the aortic arch in terms of artificial circulation and selective antegrade cerebral perfusion at the age of 1 year at the Amosov National Institute of Cardiovascular Surgery and the Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery in the period from 2014 to 2019 were analyzed. To study the cognitive sphere and motor development of children we used the 2nd edition of the method "Bayley Scales of Infant Development - II". In analyzing the results in children with psychomotor developmental delay, the values of the mental index and the index of psychomotor development were taken into account. Results. 2 (3.7%) patients died after surgery. Postoperative mortality was connected with neurological complications and technique of cerebral perfusion. In the remote period no patient died. According to neurosonography in the postoperative period, no pathological structural changes in the brain were detected. In 16 (33.3%) children at the age of 1 year there was a slight delay in mental and / or psychomotor development. Evaluation of the results of the survey in the dynamics showed that at the age of 3 years, 9 (18.7%) children had a slight development delay. The average values of the mental index in 1 year were 81.2 ± 8.6, and in 3 years - 96.4 ± 12.7 (p <0.05), and the index of psychomotor development - respectively 83.3 ± 11.4 and 94.5 ± 10.2 (p <0.05). The difference between the indicators of mental and psychomotor indices in children with congenital heart disease at 1 year and 3 years is statistically significant. Conclusions. A delay in psychomotor development at the age of 1 year was revealed in 33.3% of children after the aortic arch reconstruction in the conditions of selective antegrade cerebral perfusion. This indicates the need for further research and monitoring. A statistically significant difference between the indicators of mental and psychomotor development of children aged 1 and 3 years after aortic arch reconstruction indicates a positive dynamics and recovery of psychomotor development with age in most of children.

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