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Normothermic Aortic Arch Repair in Newborns and Infants versus Hypothermia Perfusion: Still is Another Option or Results are Better?


  • #CH/NEW 01-EP-6
  • Congenital Heart Surgery/Newborn Critical Congenital Cardiac. E-POSTER (ORAL) SESSION
  • E-Poster (oral)

Normothermic Aortic Arch Repair in Newborns and Infants versus Hypothermia Perfusion: Still is Another Option or Results are Better?

Vladlen V. Bazylev, Igor E. Chernogrivov, Michail V. Kokashkin, Shakhriiar F. Suleimanov, Aleksei E. Chernogrivov

Federal State Center for cardiovascular Surgery, Penza, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: Normothermic perfusion during arch repair is safely used by some authors but all effects are to be established. We therefore further comparatively assessed the arch-repair normothermic (NAR) and hypothermic (HAR) bypass techniques for management of newborns and infants with aortic arch pathology.

Methods: 73 neonates and infants with interruption or coarctation of the aorta were operated between November 2008 and January 2017 including major intracardiac pathology. 32 (43.8%) of them (22; 50%) were operated using normothermic (NAR; t>34°) and antegrade selective cerebral perfusion (CP) meanwhile other 41 (56.2%) (HAR; t<28°) were operated either with hypothermic continuous cerebral perfusion (37; 50.7%) or under deep hypothermia with circulatory arrest (4; 5.5%). 69 patients were monitored intraoperatively by near-infrared spectroscopy. Mediana age, body weight and basic Aristotle were respectively 15 d, 3.2 kg and 9.7 (NAR) versus 19 d, 3.4 kg and 9.0 (HAR) (P = 0.7; 0.2; 0.7). As well the preoperative need for mechanical lung ventilation (MLV) was similar (p=0.26). We analyzed about 150 pre- and postoperative characteristics.

Results: Early mortality was 6.25% in NAR group versus 9.75% in HAR (p=0.58). Group NAR demonstrated as higher CP velocity as the perfusion flows (p<0.001) and had significantly shorter the duration of bypass and all time of operation. Balance of urine during bypass, time to extubation and of inotropic infusion, frequency of complications, stay in hospital were similar but lactate level immediately after repair had a tendency to be higher in group HAR (p=0.06).

Conclusion: NAR has outcomes comparable with HAR but the possibilities of decreasing the time of bypass could be potentially beneficial. But apparently the normothermic perfusion during complex surgery has mutlifactorial influence and it needs to be evaluated in a larger number of patients with a longer follow-up than what we have now.


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