Moderately Hypothermic Cardiopulmonary Bypass and Low-Flow Antegrade Selective Cerebral Perfusion for Neonatal Aortic Arch Surgery

Oppido, Guido; Napoleone, Carlo Pace; Turci, Simone; Davies, Ben; Frascaroli, Guido; Suàrez, Sofia Martìn; Giardini, Alessandro; Gargiulo, Gaetano

doi:10.1016/j.athoracsur.2006.06.042

Cited by 48 publications

(49 citation statements)

References 24 publications

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“…For this reason, it has been suggested that selective cerebral perfusion may improve neurologic outcome. 10,11 More studies are needed to evaluate whether regional cerebral perfusion does decrease seizures in the postoperative period, or improve long-term developmental outcomes.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Electroencephalography Predicts Postoperative Seizures in Infants With Congenital Heart Disease

Seltzer

Swartz

Kwon

et al. 2014

Pediatric Neurology

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BACKGROUND During the surgical repair of infants with congenital cardiac defects, there can be periods of decreased cerebral blood flow, particularly during deep hypothermic circulatory arrest (DHCA). As a result, these infants are at increased risk for seizures and long-term neuro-developmental difficulties. METHODS Thirty-two infants with congenital heart disease had continuous video-EEG monitoring pre-, intra-, and post-operatively for 48 hours following surgery. RESULTS: For patients requiring DHCA (n=17) the EEG pattern for all patients became suppressed and eventually isoelectric below 25°C. Two of the 32 infants had electrical seizures within the 48 hour monitoring window. Both required DHCA and the burst pattern during recovery had rhythmic, sharp components that were high amplitude and often asynchronous between the hemispheres. The interval between the onset of seizure activity, and initiation of the sharp burst pattern during surgery, was 29 and 40 hours. This pattern was not observed during isoelectric recovery from infants who did not develop post-operative seizures. CONCLUSIONS The EEG in infants during DHCA displayed predictable changes. We identified an EEG pattern following the isoelectric period that may be predictive of seizure development in the subsequent 48 hours.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Electroencephalography Predicts Postoperative Seizures in Infants With Congenital Heart Disease

Seltzer

Swartz

Kwon

et al. 2014

Pediatric Neurology

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“…Moderate hypothermia with ACP has been explored in Europe and Asia for neonatal arch operations, although the typical practice in North America has been to use deep hypothermia with ACP or DHCA alone. Oppido et al reported 17% early mortality and 8.5% late deaths over a follow-up of up to 50 months in a group of 70 consecutive neonates who underwent the Norwood procedure or aortic arch repair at a nasopharyngeal temperature of 25 ℃ with ACP (18). Only one patient had postoperative seizures.…”

Section: Discussionmentioning

confidence: 99%

“…In newborns and infants, extended end-to-end repair of coarctation is performed routinely at near-normothermia with all cerebral and systemic perfusion achieved via the innominate artery for periods of approximately 20 minutes, without clinically significant neurological or end-organ injury (17). Notwithstanding, few reports evaluate the use of moderate hypothermia for ACP in neonates and children undergoing aortic arch reconstructions (11,12,(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine

et al. 2016

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Background: Antegrade cerebral perfusion (ACP) typically is used with deep hypothermia for cerebral protection during aortic arch reconstructions. The impact of ACP on cerebral oxygenation and serum creatinine at a more tepid 25 ℃ was studied in newborns and children.Methods: Between 2010 and 2014, 61 newborns and children (<5 years old) underwent aortic arch reconstruction using moderate hypothermia (25.0±0.9 ℃) with ACP and a pH-stat blood gas management strategy. These included 44% Norwood-type operations, 30% isolated arch reconstructions, and 26% arch reconstructions with other major procedures. Median patient age at surgery was 9 days (range, 3 days-4.7 years). Cerebral oxygenation (NIRS) was monitored continuously perioperatively for 120 hours.Serum creatinine was monitored daily.Results: Median cardiopulmonary bypass (CPB) and cross clamp times were 181 minutes (range, 82-652 minutes) and 72 minutes (range, 10-364 minutes), respectively. ACP was performed at a mean flow rate of 46±6 mL/min/kg for a median of 48 minutes (range, 10-123 minutes). Cerebral and somatic NIRS were preserved intraoperatively and remained at baseline postoperatively during the first 120 hours.Peak postoperative serum creatinine levels averaged 0.7±0.3 mg/dL for all patients. There were 4 (6.6%) discharge mortalities. Six patients (9.8%) required ECMO support. Median postoperative length of hospital and intensive care unit (ICU) stay were 16 days(range, 4-104 days) and 9 days (range, 1-104 days), respectively. Two patients (3.3%) received short-term peritoneal dialysis for fluid removal, and none required hemodialysis. Three patients (4.9%) had an isolated seizure which resolved with medical therapy, and none had a neurologic deficit or stroke.Conclusions: ACP at 25 ℃ preserved perioperative cerebral oxygenation and serum creatinine for newborns and children undergoing arch reconstruction. Early outcomes are encouraging, and additional study is warranted to assess the impact on late outcomes.

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“…Evidence for this is seen from studies of human infants under SCP documenting the relationship of flow and ipsilateral arterial blood pressure. Human infants under alpha‐stat blood gas management (cerebral vasoconstriction) had the same flow‐pressure relationships as the piglet: Flow rates of 20‐30 mL/kg/min resulted in ipsilateral arterial pressures of 35‐40 mm Hg. However, the use of pH‐stat blood gas management (cerebral vasodilation) gives a dramatically different result in the human infant: flow rates of 50‐80 mL/kg/min resulted in ipsilateral arterial pressures of 35‐45 mm Hg.…”

Section: Surgical and Cardiopulmonary Bypass Techniques And Their Impmentioning

confidence: 99%

Neurologic outcomes after heart surgery

Fang

Allen

Marino

et al. 2019

Pediatric Anesthesia

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Moderately Hypothermic Cardiopulmonary Bypass and Low-Flow Antegrade Selective Cerebral Perfusion for Neonatal Aortic Arch Surgery

Cited by 48 publications

References 24 publications

Intraoperative Electroencephalography Predicts Postoperative Seizures in Infants With Congenital Heart Disease

Intraoperative Electroencephalography Predicts Postoperative Seizures in Infants With Congenital Heart Disease

Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine

Neurologic outcomes after heart surgery

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