Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware; Division of Behavioral Health, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Ann Thorac Surg. 2014 Jul;98(1):119-24. doi: 10.1016/j.athoracsur.2014.02.042. Epub 2014 Apr 14.
Optimal perfusion strategies for neuroprotection during infant cardiac surgery remain undefined. Despite encouraging experimental data, neurodevelopmental (ND) outcomes after cardiac surgery in neonates and infants using deep hypothermic circulatory arrest (DHCA) with a period of intermittent perfusion have not been reported, and it is not known whether DHCA can be extended while preserving ND outcomes.
Cross-sectional ND evaluation with the Bayley Scales of Infant and Toddler Development, Third Edition was conducted at 24 months of age. Retrospective clinical data were extracted from the electronic medical record.
Forty patients underwent cardiac surgery during the first year of life using a period of uninterrupted DHCA (24 patients) or DHCA interrupted by a period of intermittent perfusion (16 patients). Total duration of DHCA ranged from 5 to 74 minutes and did not predict ND scores. Despite a longer exposure to DHCA in the intermittent perfusion group (55 minutes [1,3 interquartile [IQ] 45.3 to 65.5] versus 38 minutes [1,3 IQ 32 to 40.8]), no differences in ND scores were detected. Significant comorbidities, duration of intensive care unit and hospital stay, as well as multiple procedures with DHCA were independent predictors of ND outcomes at 24 months of age.
Despite extended duration of total DHCA, the use of a period of intermittent perfusion to limit uninterrupted DHCA periods to less than 45 minutes could lead to ND outcomes similar to those of patients exposed to brief periods of DHCA. Deep hypothermic circulatory arrest with intermittent perfusion may facilitate implementation of prospective studies to identify the optimal cerebral perfusion strategy.
在婴儿心脏手术中，用于神经保护的最佳灌注策略仍未确定。尽管有令人鼓舞的实验数据，但使用深低温停循环（DHCA）并间歇性灌注一段时间的新生儿和婴儿心脏手术后的神经发育（ND）结果尚未报道，也不知道是否可以延长 DHCA 而不影响 ND 结果。
在 24 个月大时，使用贝利婴幼儿发育量表第三版进行横断面 ND 评估。从电子病历中提取回顾性临床数据。
40 名患者在生命的第一年接受了心脏手术，使用了一段时间不间断的 DHCA（24 名患者）或 DHCA 被间歇性灌注期打断（16 名患者）。DHCA 的总持续时间从 5 分钟到 74 分钟不等，与 ND 评分无关。尽管间歇性灌注组的 DHCA 暴露时间更长（55 分钟[1,3 四分位距[IQ]45.3 至 65.5]比 38 分钟[1,3 IQ 32 至 40.8]），但 ND 评分没有差异。显著的合并症、重症监护病房和住院时间的长短，以及多次 DHCA 手术是 24 个月时 ND 结果的独立预测因素。
尽管 DHCA 的总持续时间延长，但使用间歇性灌注期将不间断的 DHCA 期限制在 45 分钟以内，可能导致与暴露于短暂 DHCA 期的患者相似的 ND 结果。间歇性灌注的深低温停循环可能有助于实施前瞻性研究，以确定最佳的脑灌注策略。
