Objectives: The refinement of cardiopulmonary bypass techniques has led to an improvement of
organ protective methods during aortic arch surgery. Using three separate roller pumps,
individual management of simultaneous cerebral, myocardial, and descending aortic
perfusion, hence “goal directed perfusion”, is feasible. The aim of the present retrospective
study was to assess short-term and mid-term results of patients with biventricular
morphology who underwent regional cerebral and distal aortic perfusion during aortic
arch repair for congenital lesions.
Methods: From December 2013 to November 2017, 21 patients with biventricular morphology underwent
aortic arch surgery under regional cerebral and distal aortic perfusions. Twelve of
them (57%) had an additional period of selective myocardial perfusion. Median weight
was 3.6 kg (range: 2.2–89 kg). Age spectrum included 12 neonates, 2 toddlers, 2 children
(2 and 6 years), and 5 adults (range: 18–42 years). Two neonates, one with Taussig–Bing
anomaly and one with common arterial trunk type A4, underwent staged repair. Data
of near-infrared spectroscopy (NIRS) and lactate levels were collected during the
procedure.
Results: The median cardiopulmonary bypass time was 195 minutes (37–427 minutes). The median
regional oximetry levels measured by NIRS during regional cerebral and distal aortic
perfusions at the left and right hemispheres, and renal region were 71% (range: 61–87%),
75% (range: 56–82%), and 79% (range: 69–92%), respectively (p = n.s.). Level of median peak perioperative lactate until first postoperative day
was 6.1 mmol/L (range: 2.3–12.8 mmol/L). Hospital mortality was 4.8% (n = 1) for the whole cohort. One patient with hypoplastic left heart complex died early
due to failed biventricular repair after secondary Norwood procedure. One patient
after primary repair of common arterial trunk with hypoplastic aortic arch died late
abroad of noncardiac course. One and 5-year survival was 91 ± 6%, respectively.
Conclusion: Selective regional cerebral and distal aortic perfusions enable an adequate management
of end-organ perfusion during aortic arch repair as expressed by levels of regional
saturations. Particularly for patients with biventricular morphology, outcomes after
arch repair with “goal-directed perfusion” techniques meet the claim of procedural
safety.
