Application of moderate hypothermia while performance of the aortal arch reconstruction in new-born babies in conditions of selective antegrade cerebral perfusion
Abstract
Objective. To estimate a security of application of moderate hypothermia while performing the aortal arch reconstruction in new-born babies in conditions of selective antegrade cerebral perfusion.
Materials and methods. In 2010-2019 yrs period in Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardio-Surgery in 64 new-born babies the aortal arch reconstruction was performed in conditions of selective antegrade cerebral perfusion in moderate hypothermia. In the investigation only patients with a two-ventricle physiology, in whom further two-ventricular correction was conducted, were included. There were 48 (75%) boys and 16 (25%) girls. Median age of the patients was (1.6 ± 0.8) mo, median body mass - (3.8 ± 1.1) kg, median square of the body surface - (0.24 ± 0.04) m². Echocardiographic investigation and neurosonography were the main diagnostic procedures.
Results. Hospital mortality have constituted 4.7% (3 patients died). The death cases were not connected with the brain protection procedure. Duration of artificial blood circulation period have had constituted (138.4 ± 58.8) min at average, aortal clamping - (83.1 ± 40 min), selective antegrade cerebral perfusion - (24.4 ± 8.8) min. In 10 (15,6%) patients in early postoperative period the sternum persisted open. In 4 (6.2%) patients in early postoperative period convulsions were noted, which were treated successfully medicinally. Median stay in the Department of Reanimation and Intensive Therapy have constituted (7.1 ± 4.1) days. In late follow-up period the patients were seen from 1 mo till 8.5 yrs. No one patient died. While elective neurosonography conduction the brain pathological changes were absent. The neurological complications symptoms were absent as well.
Conclusion. Selective antegrade cerebral perfusion with moderate hypothermia constitutes effective and secure method of the brain protection while performance of the aortal arch reconstruction in new-born babies, using median surgical approach in conditions of artificial blood circulation.
References
Elefteriades JA. What is the best method for brain protection in surgery of the aortic arch? Straight DHCA. Cardiol Clin. 2010 May;28(2):381-7. doi: 10.1016/j.ccl.2010.02.004. PMID: 20452557.
Barratt-Boyes BG, Simpson M, Neutze JM. Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass. Circulation. 1971 May;43(5 Suppl):I25-30. doi: 10.1161/01.cir.43.5s1.i-25. PMID: 5578830.
Wypij D, Newburger JW, Rappaport LA, duPlessis AJ, Jonas RA, Wernovsky G, et al. The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg. 2003 Nov;126(5):1397-403. doi: 10.1016/s0022-5223(03)00940-1. PMID: 14666011.
Asou T, Kado H, Imoto Y, Shiokawa Y, Tominaga R, Kawachi Y, et al. Selective cerebral perfusion technique during aortic arch repair in neonates. Ann Thorac Surg. 1996 May;61(5):1546-8. doi: 10.1016/0003-4975(96)80002-S. PMID: 8633985.
Oppido G, Pace Napoleone C, Turci S, Davies B, Frascaroli G, Martin-Suarez S, et al. Moderately hypothermic cardiopulmonary bypass and low-flow antegrade selective cerebral perfusion for neonatal aortic arch surgery. Ann Thorac Surg. 2006 Dec;82(6):2233-9. doi: 10.1016/j.athoracsur.2006.06.042. PMID: 17126140.
Takeda Y, Asou T, Yamamoto N, Ohara K, Yoshimura H, Okamoto H. Arch reconstruction without circulatory arrest in neonates. Asian Cardiovasc Thorac Ann. 2005 Dec;13(4):337-40. doi: 10.1177/021849230501300409. PMID: 16304221.
Gupta B, Dodge-Khatami A, Tucker J, Taylor MB, Maposa D, Urencio M, Salazar JD. Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine. Transl Pediatr. 2016 Jul;5(3):114-24. doi: 10.21037/tp.2016.06.03. PMID: 27709092; PMCID: PMC5035759.
Lavinio A, Timofeev I, Nortje J, Outtrim J, Smielewski P, Gupta A, Hutchinson PJ, Matta BF, Pickard JD, Menon D, Czosnyka M. Cerebrovascular reactivity during hypothermia and rewarming. Br J Anaesth. 2007 Aug;99(2):237-44. doi: 10.1093/bja/aem118. Epub 2007 May 16. PMID: 17510046.
Bhalala US, Appachi E, Mumtaz MA. Neurologic Injury Associated with Rewarming from Hypothermia: Is Mild Hypothermia on Bypass Better than Deep Hypothermic Circulatory Arrest? Front Pediatr. 2016 Sep 28;4:104. doi: 10.3389/fped.2016.00104. PMID: 27734011; PMCID: PMC5039167.

This work is licensed under a Creative Commons Attribution 4.0 International License.