Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 2012 Feb;143(2):375-82. doi: 10.1016/j.jtcvs.2011.08.006. Epub 2011 Sep 8.
Deep hypothermic circulatory arrest (DHCA) and antegrade cerebral perfusion (ACP) are 2 cardiopulmonary bypass techniques applied in aortic arch repair. In recent literature, cerebral effects of both techniques have received most attention, whereas the consequences for other organs have not been thoroughly investigated. Therefore, in this study, the impact of duration of DHCA and ACP on postoperative recovery was analyzed in a cohort of neonates undergoing aortic arch reconstruction.
All consecutive neonates who underwent aortic arch reconstruction from 2004 to 2009 were included in this retrospective study. Length of stay on the intensive care unit (ICU-LOS), duration of mechanical ventilation, inotrope score, and areas under the curve (AUC) for lactate and creatinine were compared with respect to durations of DHCA and ACP, respectively. Correction for confounders was performed using multivariable linear regression.
Eighty-three neonates were included, with a 30-day mortality of 4.8%. Longer duration of DHCA was associated with longer ICU-LOS both in univariable and multivariable analyses. Similarly, duration of mechanical ventilation and lactate and creatinine AUCs increased with duration of DHCA. Inotrope score was only associated with DHCA duration in univariable analysis. Duration of ACP did not affect any of the outcome parameters.
Increasing duration of DHCA, but not ACP, during neonatal aortic arch reconstruction prolongs short-term postoperative recovery. This suggests all efforts should be made to reduce the duration of DHCA to the shortest period possible, which may be achieved by exclusive use of ACP or a combination of the 2 perfusion techniques.
深低温停循环（DHCA）和顺行性脑灌注（ACP）是两种应用于心主动脉弓修复的体外循环技术。在最近的文献中，这两种技术对大脑的影响受到了最多的关注，而对其他器官的影响则没有得到彻底的研究。因此，在这项研究中，分析了一组接受主动脉弓重建的新生儿中 DHCA 和 ACP 持续时间对术后恢复的影响。
本回顾性研究纳入了 2004 年至 2009 年期间接受主动脉弓重建的所有连续新生儿。比较了 ICU 住院时间（ICU-LOS）、机械通气时间、儿茶酚胺评分和乳酸及肌酐的 AUC 与 DHCA 和 ACP 持续时间的关系。采用多变量线性回归对混杂因素进行校正。
共纳入 83 例新生儿，30 天死亡率为 4.8%。在单变量和多变量分析中，DHCA 持续时间较长与 ICU-LOS 较长有关。同样，机械通气时间和乳酸及肌酐 AUC 随 DHCA 持续时间的增加而增加。儿茶酚胺评分仅与 DHCA 持续时间在单变量分析中相关。ACP 持续时间不影响任何结果参数。
新生儿主动脉弓重建期间 DHCA 持续时间的增加，而不是 ACP，会延长短期术后恢复。这表明应尽一切努力将 DHCA 持续时间缩短至最短，这可以通过仅使用 ACP 或两种灌注技术的组合来实现。
