Variation in Techniques of Selective Antegrade Cerebral Perfusion in Neonates Undergoing Aortic Arch Reconstruction: A Comprehensive Review.

Background: Despite the widespread adoption of selective antegrade cerebral perfusion (SACP) for neonatal aortic arch reconstruction, significant variability in techniques persists across institutions, thus reflecting limited supporting data and lack of consensus on best practices. This review aimed to characterize the use of SACP in the extant literature comprehensively and highlight variations in practice to guide future research and standardization of care.

Methods: A comprehensive search was conducted using Embase, Medline/OVID, and the National Center for Biotechnology Information/PubMed databases to identify studies published from 1999 to 2024 that contained the following terms: ("neonatal" OR "neonate" OR "newborn") AND ("aortic arch" OR "Norwood" OR "stage one") AND ("circulatory arrest" OR "cerebral perfusion"). Studies were included if they were human studies, with ≥10 patients, and with descriptions of SACP flow rates and at least 1 other variable of SACP technique.

Results: On the basis of the specified search terms, after removal of duplicate studies, 845 manuscripts were reviewed. By using the described inclusion criteria, a total of 57 studies were identified and assessed. All studies were published between 2000 and 2023, and the overall median sample size was 47 patients (interquartile range, 24-70 patients). Across these studies, targeted flow rate ranged from 10 to 100 mL/kg/min, targeted temperature ranged from 18 °C to 34 °C, and there was significant variation in monitoring strategy and response to monitoring.

Conclusions: Significant variability persists in SACP technique in neonatal patients, including flow rate, temperature, and monitoring strategies. Given the critical neurodevelopmental risks associated with this patient population, it is essential to evaluate and optimize SACP practices rigorously in neonates undergoing aortic arch reconstruction.