Impact of Whole-Body Perfusion in Postoperative Outcomes After Aortic Arch Reconstruction Surgery in Neonates and Infants

Authors

  • Rodrigo Sandoval Boburg, MD Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
  • Charlotte Faust, MD Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
  • Tobias Kruger, MD Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
  • Migdat Mustafi, MD Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
  • Harry Magunia, MD Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
  • Felix Neunhoeffer, MD Department of Pediatric Cardiology and Intensive Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
  • Michael Hofbeck, MD, PhD Department of Pediatric Cardiology and Intensive Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
  • Christian Schlensak, MD, PhD Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany

DOI:

https://doi.org/10.1532/hsf.4501

Keywords:

congenital heart surgery, organ protection, neonatal surgery, femoral cannulation, mechanical circulatory support

Abstract

Introduction: The aim of this study was to determine whether whole-body perfusion (WBP) consisting of a combined antegrade cerebral perfusion (ACP) and lower body perfusion (LBP) improves the outcome after aortic arch reconstruction surgery in neonates compared with ACP.

Methods: Sixty-five consecutive patients under one year of age who underwent aortic arch reconstruction as the main procedure or as part of a more complex surgery from 2014-2020 in our center were included. The patients were separated into two groups, according to the perfusion strategy, either ACP (34 patients) as the control group or WBP (31 patients) as the intervention group. LBP was achieved through an arterial sheath in the femoral artery. Outcome parameters were postoperative renal, gastrointestinal, and neurological complications and 30-day mortality.

Results: The patients in the WBP group showed lower intraoperative lactate levels and close to normal early postoperative renal and hepatic enzymes and LDH at PICU admission compared with the patients in the ACP group. The number of patients suffering from postoperative neurological complications and multiorgan failure was lower in the WBP group.

Conclusion: In our experience, the combined use of ACP and LBP through the femoral artery showed an improvement, regarding postoperative neurologic complications in neonates and infants undergoing aortic arch surgery.

References

Algra SO, Kornmann VN, van der Tweel I, Schouten AN, Jansen NJ, Haas F. 2012. Increasing duration of circulatory arrest but not antegrade cerebral perfusion, prolongs postoperative recovery after neonatal cardiac surgery. J Thorac Cardiovasc Surg. 143:375-82.

Algra SO, Schouten AN, van Oeveren W, van der Tweel I, Schoof PH, Jansen NJ, et al. 2012. Low-flow antegrade cerebral perfusion attenuates early renal and intestinal injury during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg. 144:1323-8, 28.e1-2.

Boburg RS, Rosenberger P, Kling S, Jost W, Schlensak C, Magunia H. 2020. Selective lower body perfusion during aortic arch surgery in neonates and small children. Perfusion. 267659119896890.

Cesnjevar RA, Purbojo A, Muench F, Juengert J, Rueffer A. 2016. Goal-directed-perfusion in neonatal aortic arch surgery. Translational pediatrics. 5:134-41.

Fernandes P, Cleland A, Adams C, Chu MW. 2012. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery. Perfusion. 27:493-501.

Fernandez-Doblas J, Ortega-Loubon C, Perez-Andreu J, Lines M, Fernandez-Molina M, Abella RF. 2018. Selective visceral perfusión improves renal Flow and hepatic function in neonatal aortic arch repair. Interactive cardiovascular and thoracic surgery. 27:395-401.

Hammel JM, Deptula JJ, Karamlou T, Wedemeyer E, Abdullah I, Duncan KF. 2013. Newborn aortic arch reconstruction with descending aortic cannulation improves postoperative renal function. The Annals of thoracic surgery. 96:1721-6;discussion 26.

Hickey GL, Dunning J, Seifert B, Sodeck G, Carr MJ, Burger HU, et al. 2015. Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardiothoracic Surgery. 48:180-93.

Hoxha S, Abbasciano RG, Sandrini C, Rossetti L, Menon T, Barozzi L, et al. 2018. Selective Cerebro-Myocardial perfusion in Complex Neonatal Aortic Arch Pathology: Midterm Results. Artificial Organs. 42:457-63.

Khwaja A. 2012. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 120(4):c179-84.

Pigula FA, Nemoto EM, Griffith BP, Siewers RD. 2000. Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg. 119:331-9.

Raees MA, Morgan CD, Pinto VL, Westrick AC, Shannon CN, Christian KG, et al. 2017. Neonatal Aortic Arch Reconstruction with Direct Splanchnic Perfusion Avoids Deep Hypothermia. The Annals of thoracic surgery. 104:2054-63.

Rajagopal SK, Emani SM, Roy N, Westgate L, Bacha EA. 2010. Acute kidney injury and regional abdominal perfusion during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg. 140:453-8.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtsche PC, Vandenbroucke JP. 2007. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS medicine. 4:e296.

Published

2022-03-24

How to Cite

Sandoval, R., Faust, C., Kruger, T., Mustafi, M., Magunia, H., Neunhoeffer, F., Hofbeck, M., & Schlensak, C. (2022). Impact of Whole-Body Perfusion in Postoperative Outcomes After Aortic Arch Reconstruction Surgery in Neonates and Infants. The Heart Surgery Forum, 25(2), E222-E228. https://doi.org/10.1532/hsf.4501

Issue

Section

Articles