Complex neonatal single ventricle palliation using antegrade cerebral perfusion

Ann Thorac Surg. 2006 Oct;82(4):1278-84; discussion 1284-5. doi: 10.1016/j.athoracsur.2006.05.017.

Abstract

Background: The efficacy of antegrade cerebral perfusion (ACP) during complex neonatal single ventricle palliation requiring arch reconstruction is uncertain. We adapted the use of ACP in early 2001 in a programmatic effort to minimize the use of deep hypothermic circulatory arrest (DHCA).

Methods: We retrospectively analyzed data of 126 consecutive patients operated on between 1995 and 2004, including stage-one palliation of hypoplastic left heart syndrome, stage-one palliation for nonhypoplastic left heart syndrome, and Damus-Kaye-Stansel procedures. Patients were divided into two groups: those repaired with prolonged DHCA only (n = 67) and those with ACP (n = 59) and usually a shorter period of DHCA. Risk was further stratified into high risk (weight < or = 2.5 kg or other cardiac lesion) and usual risk for each group.

Results: Survival at 30 days in the usual-risk groups was 72.0% DHCA and 93.2% ACP (p < or = 0.025), and in the high-risk groups it was 61.5% DHCA and 80% ACP (not significant). One-year survival in the usual-risk groups was 57.4% DHCA and 84.1% ACP (p < or = 0.01), and in the high-risk groups it was 38.5% DHCA and 46.7% ACP (not significant). Overall survival to date is 52.2% DHCA and 71.2% ACP (p < or = 0.5).

Conclusions: There is a statistically significant survival advantage for usual-risk patients with the use of ACP. Although there is a trend to improved survival in the high-risk groups, it does not reach statistical significance and long-term outcomes in these patients remains disappointing. We continue to use ACP and believe it contributes to an overall survival advantage in our institution.

MeSH terms

  • Aorta, Thoracic / surgery
  • Cardiac Surgical Procedures*
  • Cerebrovascular Circulation / physiology
  • Female
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Palliative Care*
  • Perfusion
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome