Minimizing Circulatory Arrest by Using Antegrade Cerebral Perfusion for Aortic Arch Reconstruction in Infants Causes Fewer Postoperative Adverse Events

2010 ◽  
Vol 58 (01) ◽  
pp. 17-22 ◽  
Author(s):  
J. Selder ◽  
S. Algra ◽  
F. Evens ◽  
M. Freund ◽  
J. Strengers ◽  
...  
Keyword(s):  
Adverse Events ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Aortic Arch Reconstruction ◽  
Arch Reconstruction ◽  
Antegrade Cerebral Perfusion

scholarly journals Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

2019 ◽  
Vol 1 (3) ◽  
pp. 99-104
Author(s):  
Mohamed Abdel Fouly
Keyword(s):  
Cerebral Infarction ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Surgery ◽  
Significant Difference ◽  
Arch Reconstruction ◽  
Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

scholarly journals Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

2019 ◽  
Vol 11 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Yuriy Y. Kulyabin ◽  
Yuriy N. Gorbatykh ◽  
Ilya A. Soynov ◽  
Alexey V. Zubritskiy ◽  
Alexey V. Voitov ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Unit Length ◽  
Kidney Injury ◽  
Neurological Complications ◽  
Lower Body ◽  
Aortic Arch Reconstruction ◽  
Arch Reconstruction ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

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.

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

2012 ◽  
Vol 144 (6) ◽  
pp. 1323-1328.e2 ◽  
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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