Brain preservation with selective cerebral perfusion, moderate hypothermia and low flow rate

BackgroundHypothermic circulatory arrest (HCA) is employed for aortic arch and other complex operations, often with selective cerebral perfusion (SCP). Our previous work has demonstrated real-time evidence of improved brain protection using SCP at 18°C. The purpose of this study was to evaluate the utility of SCP at warmer temperatures (25°C) and its impact on operating times.MethodsFrom 2000 to 2010, 116 patients diagnosed IAA, 40 IAA with VSD, 31 single ventricle, 19 Coa with VSD, 17 DORV, 6 TGA and 3 CAVD underwent total repair using SCP 25–23 hypothermia with low flow rate for 20–35min. Circulatory arrest (CA), cross clamp (Cx), CPB and post-op complications are retrospectively analyzed.ResultsThe mean age 12–35days, weight 1.9–4.0. The complexity of the disease was determinant in the CPB and CX time, the lowest temperature was 19 in very selected patients, the average temp. was 23°C. CA was in 18 (6.4%). 27% delay sterna closure. Wound infection 11% and 8% mortality.ConclusionOur study supports the conclusion that systemic circulatory arrest with selective cerebral perfusion at 25°C can be safely performed while providing comparable cerebral and end-organ protection to that of 18°C with SCP. In addition, the employment of a more tepid temperature allows for significantly shorter operative times, which may clinically translate into improved outcomes for children undergoing surgical repair of complex congenital heart defects