6-Year Experience with Whole-Body Perfusion in Neonatal Aortic Arch Surgery: What Have We Learned?

Background: Aortic arch hypoplasia presents a challenge for the treating physicians. The standard procedure for aortic arch reconstruction surgery is performed with antegrade cerebral perfusion (ACP) in moderate to deep hypothermia. This often leads to complications due to reduced perfusion of lower body and visceral organs. Our objective was to compare the peri- and postoperative outcomes of neonates undergoing aortic arch surgery with either ACP or whole-body perfusion (WBP) (a combination of ACP and lower body perfusion). Primary outcomes included neurological, visceral-organ, and bleeding complications as well as re-operation rates and 30-day mortality.

Methods: We performed a single center, retrospective study in which we included 95 consecutive patients from 2014 to 2022. Patients were divided into two groups; one group underwent surgery with ACP from 2014–2017 (n = 34) and the other group with WBP from 2017–2022 (n = 61). Lower body perfusion was achieved through an arterial sheath in the femoral artery connected to an extra pump during CPB, with a blood flow of 20–40 mL/min.

Results: Patients in the WBP group showed significantly lower intraoperative lactate levels and needed fewer intraoperative blood-product transfusions (p < 0.01). Patients in the WBP group showed significantly lower levels of creatinine and GPT (p < 0.01) postoperatively. The number of days on a ventilator was significantly lower in the WBP group (p = 0.03). Patients in the ACP group showed a significantly higher incidence of neurological deficits (17.6%) compared to the WBP group (3.2%) (p = 0.01). There was no difference regarding mortality between groups. Arterial puncture complications occurred in 4.9% of patients in the WBP group.

A multivariate regression model showed that ACP perfusion only and lactate level after 24 hours are significant predictors for 30-day mortality. ACP perfusion as well as ventilation time are significant predictors for postoperative multiorgan dysfunction.

Conclusion: WBP through an arterial sheath in the femoral artery is safe and feasible. It showed a significant reduction in intraoperative transfusions and postoperative neurological complications compared to ACP, without significant vascular complications in the puncture site.

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Artikel online veröffentlicht:
13. Februar 2024