Usefulness of Deep Hypothermic Circulatory Arrest and Regional Cerebral Perfusion in Children

Abstract

To compare the safety and usefulness of deep hypothermic circulatory arrest (DHCA) and regional cerebral perfusion (RCP) during pediatric open heart surgery. Between January 1, 2004 and September 30, 2012, 1250 children with congenital cardiac defect underwent corrective operation with the DHCA or RCP technique in the Shanghai Children's Medical Center. Of them, 947 cases underwent the operation with the aid of DHCA (DHCA group), and 303 cases with RCP (RCP group). The mean DHCA time was 30.64 -15.81 (7-63) minutes and mean RCP time was 36.18 -12.86 (10-82) minutes. The mortality rate was 7.18% (68/947) and 6.60% (20/30) in two groups, respectively. The postoperative incidences of temporary and permanent neurological dysfunction were 6.23% (59/947) in the DHCA group and 2.64% (8/303) in the RCP group ( p < 0.01). The incidence of other complications such as low cardiac output, renal dysfunction, and lung issues are similar in both groups. RCP is a reliable technique for cerebral protection and it facilitates time-consuming corrected procedures for complex congenital cardiac defect repair procedures.

Neonatal Aortic Arch Reconstruction With Direct Splanchnic Perfusion Avoids Deep Hypothermia

“…The last two decades have seen a widespread adoption of regional cerebral perfusion with hypothermia, with the rationale of minimizing ischemia-reperfusion injury to the brain [1][2][3][4][5][6][7][8]. More recently, moderation of hypothermia combined with antegrade selective cerebral perfusion (SCP) has been shown to be neuroprotective in neonatal aortic arch reconstruction and to reduce the postoperative inflammatory responses and kidney injury often observed after deep hypothermia alone [9][10][11].…”

The Norwood Stage 1 procedure - conduct of perfusion: 2017 Survey results from NPC-QIC member institutions

“…However, right radial monitoring during SCP, as reported in this survey, seems to dominate the practice and numerous adult and pediatric publications specify monitoring a perfusion pressure during SCP. 37,38,40,42 Flow adjustments without the guide of arterial pressures may cause sequelae unidentified until the post-operative period. Most clinicians are familiar with the deleterious effects of inadequate perfusion pressures and, as demonstrated by Halstead et al, high perfusion pressures may be deleterious as well.…”

Avoiding use of total circulatory arrest in the practice of congenital heart surgery

“…Hofer et al conclude that SACP flows should be > 30 ml/kg/min [49]. The SACP strategy of Guo and associates involved systemic cooling to rectal temperature of 18°C under pH stat and then to perfuse the brain with perfusate starting at 10 ml/kg/min increasing to 30-40 ml/kg/min with pressure of 30-40 mmHg [50]. Visconti and associates used SACP flows of 30-40 ml/ kg/min guided by the distal left radial pressure which was kept at 20-25 mmHg [51].…”