What question did this study set out to answer?

To evaluate early and short-term cardiovascular outcomes of a standardized aortic arch reconstruction strategy with simultaneous cerebral and coronary perfusion.

April 10, 2026Open Access

Standardized Beating-Heart Aortic Arch Reconstruction with Simultaneous Cerebral and Coronary Perfusion in Neonates and Infants: A Single-Center Cardiovascular Cohort Study

Key Points

To evaluate early and short-term cardiovascular outcomes of a standardized aortic arch reconstruction strategy with simultaneous cerebral and coronary perfusion.
Retrospective cohort study of 31 neonates and infants from November 2022 to December 2025
Standardized surgical protocol including extensive ductal tissue resection and perfusion strategies
Assessment of early postoperative outcomes and short-term echocardiographic follow-up
No in-hospital mortality reported among the cohort
Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 minutes, respectively
Major complications were infrequent; median ICU stay was 5 days
During follow-up, 3.2% developed recoarctation requiring reintervention
No late mortality observed during the study.

Abstract

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion. Methods: In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed. Results: The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed. Conclusions: A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings.

Bookmark

View Full Paper