Distal Aortic Perfusion with Moderate Hypothermia Is Associated with Improved Kidney Function and Survival Compared to Deep Hypothermic Arrest Especially in Neonates Undergoing Norwood Operation

Objectives: Complex aortic arch repair in deep hypothermia circulatory arrest (DHCA) versus distal aortic perfusion was compared.

Methods: A total of 126 neonates undergoing aortic arch repair between 05/2007 and 09/2019 were analyzed. Patients with hypoplastic left heart syndrome (HLHS, n = 61) undergoing Norwood operation and patients with biventricular morphology undergoing aortic arch repair (n = 65) were analyzed separately. Baseline characteristics (age, gender, ABC, and STAT risk scores), early clinical outcome measures (lactate levels, transfusion rates, ventilation time, ICU stay, 30-day mortality), and incidence of acute kidney injury (AKI, RIFLE stages 1–3) were analyzed between HLHS and non-HLHS patients undergoing DHCA (n = 19, n = 32) versus distal aortic perfusion (n = 42, n = 33) using Mann–Whitney U-test.

Result: Within the non-HLHS group, patients undergoing DHCA versus distal aortic perfusion were significantly younger: 5.5 days (4–7) versus 11 days (7–15), p < 0.001 and the body weight was significantly lower: 3.1 (2.6–3.5) versus 3.4 (3.1–3.7), p = 0.04. Despite significantly longer cardiopulmonary bypass (CPB) durations in the non-HLHS-distal aortic perfusion group: 128.5 minutes (103–166.3) versus 196 minutes (136.5–249.5), p < 0.001, fresh frozen plasma (FFP) transfusion rates (87.5 vs. 66.7%, p = 0.04) and postoperative lactate levels in mmol/L (3.2 (2.9–3.9) versus 2.6 (1.9–3.5), p < 0.01) were significantly lower in the non-HLHS-distal aortic perfusion group. Incidence of AKI did not differ between non-HLHS-DHCA and non-HLHS distal aortic perfusion. Baseline characteristics were not different between the groups HLHS-DHCA and HLHS-distal aortic perfusion. Despite significantly longer CPB durations in the HLHS-distal aortic perfusion group versus HLHS-DHCA: 147 minutes (111–180) versus 225 minutes (193–270.3), p < 0.001, transfusion rates on CPB and postoperatively (100 vs. 50% and 100 vs. 81%, p < 0.01 and p = 0.04), postoperative lactate levels in mmol/L (3.9 (2.9–4.7) versus 2.9 (2.3–3.7), p = 0.01) and 30-day mortality (36.8% versus 14.3%, p = 0.04) were significantly lower in the HLHS distal aortic perfusion versus HLHS-DHCA group. Incidence of AKI RIFLE stages 2 and 3 was significantly higher in the HLHS-DHCA versus HLHS-distal aortic perfusion (3.6% versus 9.5%, p = 0.03).

Conclusion: Distal aortic perfusion with moderate hypothermia was associated with lower transfusion rates and lactate levels in all neonates undergoing aortic arch repair and was especially beneficial in HLHS patients with improved kidney function and survival.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021