Usefulness of Regional Cerebral Perfusion Combined With Coronary Perfusion During One-Stage Total Repair of Aortic Arch Anomaly

Background. We assessed whether regional cerebral perfusion is neurologically safe during long-term follow up, and evaluated the effect of our current combined coronary perfusion strategy by comparing outcomes of nonworking beating hearts and arrested hearts under regional cerebral perfusion. Methods. From March 2000 to October 2008, 159 neonates or infants with an aortic arch anomaly underwent one-stage biventricular repair with continuous cerebral perfusion. Patients (group A, n = 111) under continuous cerebral perfusion with a nonworking beating heart using the dual-perfusion technique through the innominate artery and aortic root were compared with patients (group B, n = 48) under continuous cerebral perfusion with an arrested heart. Results. There were three hospital mortalities. A transient neurologic complication occurred in 3 patients, who recovered completely. During a mean (+/- standard deviation) of 37.9 +/- 26.3 months (range, 0.5 to 95.4 months) of follow-up, 2 late deaths occurred without abnormal neurologic development. Group A had less myocardial ischemic time, which resulted in less total inotropic and vasopressin requirements, and also less delayed sternal closure, duration of ventilator care and chest tube drainage, amount of pleural effusion, and lengths of intensive care unit and hospital stay than group B, particularly in neonates and patients with complex anomalies. Conclusions. One-stage total arch repair under regional cerebral perfusion provides an excellent means of minimizing neurologic complications during long-term follow up. Our perfusion strategy for arch anomaly under continuous cerebral perfusion with a nonworking beating heart using the dual-perfusion technique may also minimize myocardial complications and morbidities, and should be recommended, particularly in neonates and patients with complex anomalies. (Ann Thorac Surg 2010;90:50-7) (C) 2010 by The Society of Thoracic Surgeons