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Ann Thorac Surg 2006;82:2233-2239
© 2006 The Society of Thoracic Surgeons
a Pediatric Cardiac Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy
c Cardiac Anaesthesia Unit, S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy
b Pediatric Cardiac Surgery Unit, Royal Children’s Hospital, Melbourne, Australia
Accepted for publication June 15, 2006.
* Address correspondence to Dr Oppido, Pediatric Cardiac Surgery, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy (Email: guidooppido{at}yahoo.com).
Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
BACKGROUND: Although deep hypothermic circulatory arrest has been extensively used in neonates for aortic arch surgery, the brain and other organs might be adversely affected by prolonged ischemia and deep hypothermia.
METHODS: Between December 1997 and January 2005, 70 consecutive neonates underwent Norwood stage I procedure for hypoplastic left heart syndrome (group A, n = 30), or aortic arch repair for interruption or coarctation with arch hypoplasia (group B, n = 40), with antegrade selective cerebral perfusion (ASCP). Mean weights were 3.0 ± 0.2 kg and 2.8 ± 0.07 kg, and mean ages were 10 ± 3.5 days and 14 ± 10.6 days in groups A and B, respectively. Only 2 patients were older than 30 days. Core body temperature was lowered to 25°C, and mean pump flow during ASCP was initiated at 10 to 20 mL/(kg · min) and adjusted to guarantee a radial/temporal artery pressure of 30 to 40 mm Hg and venous oxygen saturation of more than 70%. Hematocrit was maintained at 30%.
RESULTS: Early mortality was 17% (group A, 23%; group B, 12.5%; p = 0.19). Six late deaths occurred (3 in each group), and at 36 months, Kaplan-Meier overall survival was 64% ± 9.2% in group A and 85% ± 5.7% in group B. One patient had postoperative seizures. Age, weight, sex, prematurity, group A, and ASCP duration did not influence early mortality.
CONCLUSIONS: Antegrade selective cerebral perfusion is a safe and effective procedure and might improve outcome of neonatal aortic arch surgery, minimizing neurologic impact without the need for deep hypothermia.
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