Neurodevelopmental Outcomes After Regional Cerebral Perfusion With Neuromonitoring for Neonatal Aortic Arch Reconstruction

• Published in: The Annals of thoracic surgery Vol. 95; no. 2; pp. 648 - 655
• Main Authors: Andropoulos, Dean B., MD, Easley, R. Blaine, MD, Brady, Ken, MD, McKenzie, E. Dean, MD, Heinle, Jeffrey S., MD, Dickerson, Heather A., MD, Shekerdemian, Lara S., MBChB, Meador, Marcie, RN, MS, Eisenman, Carol, RN, Hunter, Jill V., MBBS, Turcich, Marie, MS, Voigt, Robert G., MD, Fraser, Charles D., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2013
• Subjects: Aorta, Thoracic - surgery; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Cerebrovascular Circulation; Humans; Infant, Newborn; Monitoring, Intraoperative - methods; Nervous System - growth & development; Perfusion; Prospective Studies; Spectroscopy, Near-Infrared; Surgery; Treatment Outcome; Ultrasonography, Doppler, Transcranial; 21
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.04.070

Background In this study we report magnetic resonance imaging (MRI) brain injury and 12-month neurodevelopmental outcomes when regional cerebral perfusion (RCP) is used for neonatal aortic arch reconstruction. Methods Fifty-seven neonates receiving RCP during aortic arch reconstruction were enrolled in a prospective outcome study. RCP flows were determined by near-infrared spectroscopy and transcranial Doppler monitoring. Brain MRI was performed preoperatively and 7 days postoperatively. Bayley Scales of Infant Development III was performed at 12 months. Results Mean RCP time was 71 ± 28 minutes (range, 5 to 121 minutes) and mean flow was 56.6 ± 10.6 mL/kg/min. New postoperative MRI brain injury was seen in 40% of patients. For 35 RCP patients at age 12 months, mean Bayley Scales III Composite standard scores were: Cognitive, 100.1 ± 14.6 (range, 75 to 125); Language, 87.2 ± 15.0 (range, 62 to 132); and Motor, 87.9 ± 16.8 (range, 58 to 121). Increasing duration of RCP was not associated with adverse neurodevelopmental outcomes. Conclusions Neonatal aortic arch repair with RCP using a neuromonitoring strategy results in 12-month cognitive outcomes that are at reference population norms. Language and motor outcomes are lower than the reference population norms by 0.8 to 0.9 standard deviations. The neurodevelopmental outcomes in this RCP cohort demonstrate that this technique is effective and safe in supporting the brain during neonatal aortic arch reconstruction.