Outcomes of Cerebral and Organ Perfusion Protection Following Reconstructive Surgeries on the Aortic Arch in Newborns.

Abstract

Introduction: To assess the efficacy and safety of whole-body perfusion in newborn patients after reconstructive surgeries on the aortic arch.

Methods: In this retrospective study with propensity score matching (PSM), we evaluated the efficacy and safety of surgical treatment in newborn patients after reconstructive surgeries on the aortic arch using whole-body perfusion (n=43) and selective antegrade cerebral perfusion (n=117).

Results: After PSM, patients were divided into two well-balanced groups: the whole-body perfusion (WBP) group (n=40) and the selective antegrade cerebral perfusion (SACP) group (n=40). Acute kidney injury was observed in 22.5% of patients in the WBP group, compared to 47.5% of patients in the SACP group (p=0.034). Risk factors for acute kidney injury included the method of SACP (OR 95% CI 6.1 [1.6, 19.8]) and the inotropic index on the first day (OR 95% CI 1.09 [1.01, 1.20]). Neurological complications occurred in 9.3% of patients in the WBP group and 11.6% in the SACP group (p>0.99). The only risk factor for neurological complications was low birth weight (OR 95% CI 4.5 [2.8, 16.2], p=0.042). Postoperative mortality did not differ between groups: 2.4% in the WBP group versus 4.6% in the SACP group (p>0.99).

Discussion: Perfusion techniques for neonatal aortic arch reconstruction have evolved from deep hypothermic circulatory arrest to selective antegrade cerebral perfusion with a recent trend toward combining SACP with lower body perfusion, a strategy known as whole-body perfusion. While DHCA is still utilized in pediatric cardiac surgery, it is associated with a high risk of postoperative complications, particularly affecting the brain and internal organs. SACP has demonstrated effective cerebral protection and has been widely adopted. Detailed studies of SACP's neuroprotective strategy have enabled its safe implementation without deep hypothermia, allowing procedures to be performed at temperatures up to 26°C.

Conclusion: Whole-body perfusion during aortic arch surgery in newborns is an effective and safe organ protection technique that may reduce the incidence of acute kidney injury. A high vasoactiveinotropic score (VIS) was identified as a significant postoperative risk factor for acute kidney injury. However, prospective studies are needed to further validate the advantages of whole-body perfusion.