Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 119; no. 2; pp. 331 - 339
• Main Authors: Pigula, Frank A., Nemoto, Edwin M., Griffith, Bartley P., Siewers, Ralph D.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2000; AATS/WTSA
• Subjects: Aorta, Thoracic - surgery; Blood Volume; Brain - blood supply; Brain - metabolism; Brain Ischemia - prevention & control; Cerebrovascular Circulation; Heart Arrest, Induced; Heart Defects, Congenital - surgery; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Oxygen Consumption; Perfusion - methods; Spectroscopy, Near-Infrared; Treatment Outcome; Vascular Surgical Procedures - methods
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(00)70189-9

Objective: Because of concerns regarding the effects of deep hypothermia and circulatory arrest on the neonatal brain, we have developed a technique of regional low-flow perfusion that provides cerebral circulatory support during neonatal aortic arch reconstruction. Methods: We studied the effects of regional low-flow perfusion on cerebral oxygen saturation and blood volume as measured by near-infrared spectroscopy in 6 neonates who underwent aortic arch reconstruction and compared these effects with 6 children who underwent cardiac repair with deep hypothermia and circulatory arrest. Results: All the children survived with no observed neurologic sequelae. Near-infrared spectroscopy documented significant decreases in both cerebral blood volume and oxygen saturations in children who underwent repair with deep hypothermia and circulatory arrest as compared with children with regional low-flow perfusion. Reacquisition of baseline cerebral blood volume and cerebral oxygen saturations were accomplished with a regional low-flow perfusion rate of 20 mL · kg –1 · min –1. Conclusions: Regional low-flow perfusion is a safe and simple bypass management technique that provides cerebral circulatory support during neonatal aortic arch reconstruction. The reduction of deep hypothermia and circulatory arrest time required may reduce the risk of cognitive and psychomotor deficits. (J Thorac Cardiovasc Surg 2000;119:331-9)