Results with all blood retrograde microplegia as a myocardial protection strategy for complex neonatal arch reconstruction

Neonatal arch reconstructions present a challenge for myocardial protection. We report our results for eight patients treated with intermittent cold all blood retrograde cardioplegia during arch reconstruction using continuous selective normothermic cerebral perfusion. Over a 10-month period eight consecutive neonates underwent complex arch reconstruction. Mean age was 8.4 days (range 2-23); weight 3.1 kg (range 2.7-3.8). Diagnosis was hypoplastic left heart syndrome (5), interrupted aortic arch/ventriculoseptal defect (2), and complex AP window (1). Mean cardiopulmonary bypass time was 149 minutes (range 80-201), mean cross-clamp time was 74 (range 51-101). All patients had primary chest closure and none required extra-corporeal membrane oxigenation. One patient (12%) had a period of low cardiac output syndrome, which resolved with high dose inotropes. All patients were discharged alive and well. Intermittent all blood retrograde microplegia is an effective myocardial protection strategy for complex neonatal arch reconstruction. Postoperative myocardial function is very good. This protection approach facilitates continuous selective normothermic cerebral perfusion.