Neurological Outcome of Aortic Arch Reconstruction Using Selective Cerebral Perfusion Compared to Standard Open-Heart Surgery in Pediatric Patients: A Prospective Single-Center Study

Background: Antegrade selective brain perfusion (ASCP) is an established neuroprotective technique; however, the optimal strategy in pediatric patients remains unclear. This prospective study compares early postoperative neurological outcomes of aortic arch reconstruction using ASCP and standard open-heart surgery in pediatric patients.

Method: Between 2016 and 2020, a total of 29 patients were included to the study. Fifteen patients received ASCP (study group) and 14 patients received VSD closure (control group). Nine patients from the study group received additionally selective myocardial perfusion. Median age was 68.0 versus 282.5 days (study vs. control). From study group, one patient had incomplete VACTERL, one patient had genetic changes, and two other had syndromes associated with developmental delay. Six patients were excluded due to lack of participation to study. Twenty-three patients were evaluated with the Bayley Scales of Infant and Toddler Development third edition (BSID III) after the operation (147.5 ± 34.5 days [study group] vs. 132.2 ± 37.2 (control group); p = 0.171). Patients with univentricular palliation were excluded.

Results: Median deepest rectal temperature was 28.1 versus 34.0°C (study vs. control), median bypass time was 187.0 versus 108.5, median aortic clamping time was 54 versus 64, and median ASCP duration was 42.0 minutes. One patient had postoperative cerebral hemorrhage. One patient had thalamus infarction and a subdural hematoma. These patients were in the study group and had syndromes associated with developmental delay. Overall, 23 patients were evaluated by BSID III. Study and control group showed no significant difference concerning composite scores of cognitive, motor, and language ([Table]), but significant differences in a subtest of language skills, the scaled score for expressive communication was significantly different (p = 0.02). x ± s represents X ± 1 SD. n is the number of non-missing values. Wilcoxon's test was used.

	n	Aortic arch n = 11	VSD n = 12	p-Value
Composite score cognitive	23	82.7 ± 18.2	82.5 ± 12.0	0.651
Composite score language	23	73.5 ± 18.4	83.8 ± 18.2	0.16
Composite score motor	23	76.3 ± 21.2	80.4 ± 15.2	0.632

Conclusion: ASCP can be used safely during aortic arch reconstruction in pediatric population; however, larger study populations are warranted to verify the exact safety of ASCP.

Publication History

Article published online:
03 February 2022