ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Comparison of cases with and without additional lower body perfusion in newborns undergoing aortic arch reconstruction with antegrade selective cerebral perfusion method
Yiğit Kılıç1, Arif Selçuk2, Oktay Korun3, Hasan Ceyda4, Murat Çiçek3, Okan Yurdakök3, Fırat Altın3, Hasan Erdem5, Numan Ali Aydemir3, Ahmet Şaşmazel3
1Pediatric Cardiac Surgery, Dr. Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
2Pediatric Cardiac Surgery, Cengiz Gökçek Obstetrics and Gynecology Hospital, Gaziantep, Türkiye
3Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
4Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
5Department of Cardiovascular Surgery, Kartal Koşuyolu Yüksek Ihtisas Training and Research Hospital, Istanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2022.22805
Background: The aim of this study was to analyze the effect of additional lower body perfusion, compared to antegrade selective cerebral perfusion, on early postoperative outcomes after aortic arch repair in neonates with biventricular morphology.

Methods: Between January 2017 and April 2020, a total of 46 neonates (34 males, 12 females; median age: 10 days; range, 7 to 14 days) with biventricular morphology underwent an aortic arch reconstruction were retrospectively analyzed. The effects of antegrade selective cerebral perfusion and additional lower body perfusion techniques on vital organ preservation and mortality were evaluated in these patients who underwent arch reconstruction.

Results: In the univariate analysis of the whole cohort, postoperative creatinine level was lower in the additional lower body perfusion group, while there was no significant difference between the other parameters. In the multivariate analysis, intraoperative highest lactate level (odds ratio: 1.7; 95% confidence interval: 1.07-2.68; p=0.02) and postoperative 4th t o 6 th h lactate levels (odds ratio: 2.34; 95% confidence interval: 1.08-5.09; p=0.03) were independent predictors of early mortality. Mortality rate was higher in the antegrade selective cerebral perfusion group (22% vs. 7%), although it did not reach statistical significance. In the receiver operating characteristic curve analysis, the cut-off value for intraoperative lactate was 6.2 mmol/L (sensitivity: 85.7%, specificity: 71.1%) and the cut-off value for the lactate level at the postoperative 4th to 6th h was 4.9 mmol/L (sensitivity: 85.7%, specificity: 73.7%). Above these lactate levels were found to be associated with mortality.

Conclusion: Additional lower body perfusion may have a role in vital organ protection in aortic arch repair of neonates, compared to antegrade selective cerebral perfusion.

Keywords : Aortic arch repair, cannulation technique, descending aortic cannulation
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