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Ann Thorac Surg 2006;82:1278-1285
© 2006 The Society of Thoracic Surgeons
Congenital Heart Institute, Miami Children's Hospital, and Arnold Palmer Hospital, Miami and Orlando, Florida
Accepted for publication May 5, 2006.
* Address correspondence to Dr Hannan, Division of Cardiovascular Surgery, Miami Children's Hospital, 3200 SW 62nd Court, Suite 102, Miami, FL 33155 (Email: rhannan001{at}aol.com).
Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
BACKGROUND: The efficacy of antegrade cerebral perfusion (ACP) during complex neonatal single ventricle palliation requiring arch reconstruction is uncertain. We adapted the use of ACP in early 2001 in a programmatic effort to minimize the use of deep hypothermic circulatory arrest (DHCA).
METHODS: We retrospectively analyzed data of 126 consecutive patients operated on between 1995 and 2004, including stage-one palliation of hypoplastic left heart syndrome, stage-one palliation for nonhypoplastic left heart syndrome, and Damus-Kaye-Stansel procedures. Patients were divided into two groups: those repaired with prolonged DHCA only (n = 67) and those with ACP (n = 59) and usually a shorter period of DHCA. Risk was further stratified into high risk (weight 
2.5 kg or other cardiac lesion) and usual risk for each group.
RESULTS: Survival at 30 days in the usual-risk groups was 72.0% DHCA and 93.2% ACP (p 0.025), and in the high-risk groups it was 61.5% DHCA and 80% ACP (not significant). One-year survival in the usual-risk groups was 57.4% DHCA and 84.1% ACP (p 0.01), and in the high-risk groups it was 38.5% DHCA and 46.7% ACP (not significant). Overall survival to date is 52.2% DHCA and 71.2% ACP (p 0.5).
CONCLUSIONS: There is a statistically significant survival advantage for usual-risk patients with the use of ACP. Although there is a trend to improved survival in the high-risk groups, it does not reach statistical significance and long-term outcomes in these patients remains disappointing. We continue to use ACP and believe it contributes to an overall survival advantage in our institution.
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