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Ann Thorac Surg 2001;72:401-407
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery

Frank A. Pigula, MDa, Sanjiv K. Gandhi, MDa, Ralph D. Siewers, MDa, Peter J. Davis, MDa, Steven A. Webber, MDa, Edwin M. Nemoto, PhDa

a Division of Pediatric Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Address reprint requests to Dr Pigula, Pediatric Cardiothoracic Surgery, Room 2820, 2 Main, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213
e-mail: pigulaf{at}heart.chp.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. Regional low-flow perfusion has been shown to provide cerebral circulatory support during neonatal aortic arch operations. However, its ability to provide somatic circulatory support remains unknown.

Methods. Fifteen neonates undergoing arch reconstruction with regional perfusion were studied. Three techniques were used to assess somatic perfusion: abdominal aortic blood pressure, quadriceps blood flow (near-infrared spectroscopy), and gastric tonometry.

Results. Twelve patients required operation for hypoplastic left heart syndrome, and 3 required arch reconstruction with a biventricular repair. There was one death (7%). Abdominal aortic blood pressure was higher (12 ± 3 mm Hg versus 0 ± 0 mm Hg), and quadriceps blood volumes (5 ± 24 versus -17 ± 26) and oxygen saturations (57 ± 25 versus 33 ± 12) were greater during regional perfusion than during deep hypothermic circulatory arrest (p < 0.05). During rewarming, the arterial–gastric mucosal carbon dioxide tension difference was lower after circulatory arrest than after regional perfusion (-3.3 ± 0.3 mm Hg versus 7.8 ± 7.6 mm Hg, p < 0.05).

Conclusions. Regional low-flow perfusion provides somatic circulatory support during neonatal arch surgical procedures. Support of the subdiaphragmatic viscera should improve the ability of neonates to survive the postoperative period.




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