Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction

Byline: Frank A. Pigula, Edwin M. Nemoto, Bartley P. Griffith, Ralph D. Siewers Abstract: Objective: Because of concerns regarding the effects of deep hypothermia and circulatory arrest on the neonatal brain, we have developed a technique of regional low-flow perfusion that provides cerebral circulatory support during neonatal aortic arch reconstruction. Methods: We studied the effects of regional low-flow perfusion on cerebral oxygen saturation and blood volume as measured by near-infrared spectroscopy in 6 neonates who underwent aortic arch reconstruction and compared these effects with 6 children who underwent cardiac repair with deep hypothermia and circulatory arrest. Results: All the children survived with no observed neurologic sequelae. Near-infrared spectroscopy documented significant decreases in both cerebral blood volume and oxygen saturations in children who underwent repair with deep hypothermia and circulatory arrest as compared with children with regional low-flow perfusion. Reacquisition of baseline cerebral blood volume and cerebral oxygen saturations were accomplished with a regional low-flow perfusion rate of 20 mL * kg.sup.-1 * min.sup.-1. Conclusions: Regional low-flow perfusion is a safe and simple bypass management technique that provides cerebral circulatory support during neonatal aortic arch reconstruction. The reduction of deep hypothermia and circulatory arrest time required may reduce the risk of cognitive and psychomotor deficits. (J Thorac Cardiovasc Surg 2000;119:331-9) Author Affiliation: Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pa. Article History: Received 29 June 1999; Revised 19 July 1999; Revised 11 August 1999; Accepted 13 August 1999 Article Note: (footnote) [star] Read at the Twenty-fifth Annual Meeting of The Western Thoracic Surgical Association, Olympic Valley (Lake Tahoe), Calif, June 23-26, 1999., [star][star] Address for reprints: Frank A. Pigula, MD, Department of Pediatric Cardiothoracic Surgery, Room 2820, 2 Main, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213 (E-mail: Pigulaf@heart.chp.edu) , a 0022-5223/2000 $12.00 + 0 12/6/102479