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Selective versus standard cerebro‐myocardial perfusion in neonates undergoing aortic arch repair: A multi‐center study

机译：选择性与标准脑心肌灌注在新生儿接受主动脉弓修复：多中心研究

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Abstract The results of neonatal aortic arch surgery using cerebro‐myocardial perfusion were analyzed. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard perfusion, using a single pump rotor with an arterial line Y‐connector. Between May 2008 and May 2016, 69 consecutive neonates underwent arch repair using either selective cerebro‐myocardial perfusion (Group A, n ?=?34) or standard perfusion (Group B, n ?=?35). The groups were similar for age, weight, BSA, prevalence of one‐stage or staged repair, and single ventricle palliation; male gender was more frequent in Group A. The duration of the cerebro‐myocardial perfusion was comparable (27?±?8 vs. 28?±?7 min, P ?=?0.9), with higher flows in Group A (57?±?27 vs. 39?±?19 mL/kg/min, P? =?0.01). Although cardioplegic arrest was more common in Group B (13/34 vs. 23/35, P ?=?0.03), the duration of myocardial ischemia was longer in Group A (64?±?41 vs. 44?±?14 min, P ?=?0.04). There was 1 hospital death in each group, with no permanent neurological injury in either group. Cardiac morbidity (1/34 vs. 7/35, P? =?0.02) was more common in Group B, while extracardiac morbidity was similar in both the groups. During follow‐up (3.2?±?2.4 years), 5 late deaths occurred with a comparable 5‐year survival rate (75?±?17% vs. 88?±?6%, P? =?0.7) and freedom from arch reintervention (86?±?6% vs. 84?±?7%, P? =?0.6). Risk of cardiac morbidity was greater with standard cerebro‐myocardial perfusion (OR?=?5.2, CI 3.3–6.8, P ?=?0.001) and with perfusion flows less than 50 mL/kg/min (OR 3.7, CI 1.87–5.95, P? =?0.04). Cerebro‐myocardial perfusion is a safe and effective strategy to protect the brain and heart in neonates undergoing arch repair. Selective techniques using higher perfusion flows may further attenuate cardiac morbidity.
机译：摘要分析了使用脑心肌灌注的新生儿主动脉弓手术的结果。使用带有动脉线Y接头的单个泵转子使用两个单独的泵转子的选择性脑和心肌灌注。 2008年5月至2016年5月，连续的新生儿使用选择性脑心肌灌注（A，N？= 34）或标准灌注（B组，N？= 35组）进行69次进行弓形修复。该群体类似于年龄，体重，BSA，单级或分阶段修复的患病率，以及单脑室间隙; A组中的男性性别更频繁。脑心肌灌注的持续时间相当±27 vs. 39？±19 ml / kg / min，p？= 0.01）。虽然B组（13/34与23/35，p？= 0.03），心脏停搏停止更常见，但在A组（64？±41对44.±141℃时，心肌缺血的持续时间更长，p？= 0.04）。每组有1位医院死亡，两组无常用神经损伤。心脏病（1/34与7/35，p？= 0.02）在B组中更常见，而尤文氏菌在两组中也相似。在随访期间（3.2？±2.4岁），5年发生5年生存率（75？±17％vs.88？±6％，P？=？0.7）和自由拱门重新入住（86？±6％与84？±7％，p？= 0.6）。具有标准脑心肌灌注（或α= 5.2，C1.3-6.8，p≤00.2.2），灌注流量小于50ml / kg / min（或3.7，ci 1.87-5.95 ，p？= 0.04）。脑心肌灌注是一种安全有效的策略，可以保护新生儿拱门修复的新生儿和心脏。使用更高灌注流的选择性技术可能进一步衰减心脏病发病率。

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