Key result
Moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion significantly reduced the rate of neurologic complications (4.9% vs 18.9%, p=0.019) compared to deep hypothermic circulatory arrest in pediatric aortic arch surgery.
Why the study?
The safety and efficacy of selective antegrade cerebral perfusion in children undergoing aortic arch surgery are unclear.
Does MHCA plus SACP improve short-term outcomes compared to DHCA in children undergoing aortic arch surgery?
Cohort (n=114)
No
Does MHCA plus SACP improve short-term outcomes compared to DHCA in children undergoing aortic arch surgery?
Absolute Event Rate: 4.9% vs 18.9%
p-value: p=0.019
In children undergoing aortic arch surgery, MHCA with SACP is associated with better short-term outcomes, including fewer neurologic complications and shorter ICU stays, compared to DHCA.
May support MHCA + SACP in pediatric aortic arch repair; leaves open need for prospective randomized confirmation.
The safety and efficacy of selective antegrade cerebral perfusion (SACP) in children undergoing aortic arch surgery are unclear. In this retrospective analysis, we compared moderate hypothermic circulatory arrest (MHCA; n = 61) plus SACP vs deep hypothermic circulatory arrest (DHCA; n = 53) in children undergoing aortic arch surgery during a period from January 2008 to December 2017. Demographic characteristics and the underlying anomalies were comparable between the two groups. The MHCA + SACP group had shorter cardiopulmonary bypass (CPB) time (146.9 ± 40.6 vs 189.6 ± 41.2 min for DHCA; p < 0.05) and higher nasopharyngeal temperature (26.0 ± 2.1 vs 18.9 ± 1.6 °C; p < 0.01). The MHCA + SACP group had lower rate of neurologic complications (3/61 vs 10/53 for DHCA; p < 0.05) but not complications in other organ systems. The MHCA + SACP group also had less 24-hour chest drainage (median, interquartile rage: 28.9, 12.6-150.0 vs 47.4, 15.2-145.0 ml/kg for DHCA; p < 0.05), shorter duration of postoperative mechanical ventilation (35.0, 15.4-80.3 vs 94.0, 42.0-144.0 h; p < 0.01), and shorter stay in intensive care unit (3.9, 3.0-7.0 vs 7.7, 5.0-15.0 d; p < 0.05). In regression analysis, in-hospital mortality was associated with longer CPB time. In conclusion, MHCA + SACP is associated with better short-term outcomes in children receiving aortic arch surgery under CPB.
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Xie et al. (2020) conducted a cohort in Pediatric aortic arch anomalies (Coarctation of the aorta or interrupted aortic arch) (n=114). Moderate hypothermic circulatory arrest (MHCA) plus selective antegrade cerebral perfusion (SACP) vs. Deep hypothermic circulatory arrest (DHCA) was evaluated on Neurologic complications (p=0.019). Moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion significantly reduced the rate of neurologic complications (4.9% vs 18.9%, p=0.019) compared to deep hypothermic circulatory arrest in pediatric aortic arch surgery.
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