Triple-Arterial Cannulation for Whole-Body Perfusion during Complex Aortic Arch Reconstruction in Newborns Improves Clinical Outcome: A Matched-Pair Analysis

Objectives: The aim of this study was to evaluate the feasibility and clinical outcome of two different perfusion strategies during complex aortic arch reconstruction (AAR) in newborns.

Methods: Between 2018 and 2019, 24 patients (pts) underwent AAR, with either deep hypothermic circulatory arrest and antegrade cerebral perfusion on the cardioplegic heart (12 pts.; mean age 6 ± 13 days, mean weight 3.7 ± 3.8, group A) or whole-body-perfusion (WBP; cerebral, myocardial, and visceral) on the beating heart (12 pts.; mean age 5 ± 15 days, mean weight 3.4 ± 4.9 kg, group B). Primary end points were 30-day mortality, duration of mechanical ventilation, length of intensive care unit stay (ICU-stay), and specific organ parameters of metabolic recovery. Minimizing baseline differences, a matched-pair analysis was performed.

Results: 30-day mortality was 0%. Duration of mechanical ventilation (45 ± 11 vs. 60 ± 16, p < 0.001) and ICU-stay (119 ± 24 vs. 163 ± 3, p < 0.001) were significantly shorter in group B. The levels of troponin T and CK-MB (2.1 ± 0.4 vs. 9.4 ± 3.3 ng/mL, p < 0.001; 57 ± 18 vs. 171 ± 35 U/L, p < 0.001), lactate on arrival at the ICU (1.9 ± 1.1 vs. 3.5 ± 3.3 ng/mL, p = 0.2) were also significantly lower in group B. Postoperative renal function revealed a tendency to be better preserved in group B (0.48 ± 0.2 vs. 0.51 ± 0.15, p = 0.2). Demographic data (age, weight, and gender) were comparable between groups A and B.

Conclusion: Triple-arterial cannulation is a feasible and safe approach for perfusion of the brain, myocardium, and the lower parts of the body during AAR in newborns and reduces myocardial damage and improves clinical outcome.