Fernández-Doblas Joaquín, Ortega-Loubon Christian, Pérez-Andreu Joaquín, Linés Marcos, Fernández-Molina Manuel, Abella Raúl F
Department of Paediatric Cardiac Surgery, Vall d'Hebron Hospital, Barcelona, Spain.
Neonatal Cardiac Intensive Care Unit, Vall d'Hebron Hospital, Barcelona, Spain.
Interact Cardiovasc Thorac Surg. 2018 Sep 1;27(3):395-401. doi: 10.1093/icvts/ivy091.
The aortic arch repair in the neonatal period is a complex procedure with significant morbidity. We define a useful double-perfusion technique and its effect on the function of abdominal organs in the postoperative course.
Nine patients with double perfusion (Group 1) were compared with 14 patients with antegrade cerebral perfusion (Group 2). The objective was to discern the incidence of postoperative acute kidney injury and impaired hepatic function, as well as tissue perfusion and myocardial function parameters. Mechanical ventilation time, postoperative length of stay and 30-day mortality were measured. We excluded patients with extracorporeal membrane oxygenation, early mortality (<72 h) and preoperative renal or hepatic insufficiency.
Nine (39%) patients developed postoperative acute kidney injury, with 22% (n = 2) in Group 1 and 50% (n = 7) in Group 2 (P = 0.183). A higher urine output was observed during the first 24 h for Group 1 (P = 0.032). Eleven patients developed impaired hepatic function in the immediate postoperative period: 2 (18.2%) in Group 1 and 9 (81.8%) in Group 2 (P = 0.04). The international normalized ratio (P = 0.006-0.031) and prothrombin time (P = 0.007-P = 0.016) were significantly lower in the double-perfusion group during the first 72 h. Significant difference was observed in lactate levels in the first 72 h (P = 0.001-0.009). There was no postoperative mortality in either group.
Selective visceral perfusion is a safe procedure that provides a better urine output, hepatic function and tissue perfusion. This technique allows for the repair of complex aortic arch anomalies in neonates without deep hypothermic circulatory arrest.
新生儿期主动脉弓修复是一项复杂手术，并发症发生率高。我们定义了一种有用的双灌注技术及其对术后腹部器官功能的影响。
将9例采用双灌注的患者（第1组）与14例采用顺行性脑灌注的患者（第2组）进行比较。目的是辨别术后急性肾损伤和肝功能受损的发生率，以及组织灌注和心肌功能参数。测量机械通气时间、术后住院时间和30天死亡率。我们排除了接受体外膜肺氧合、早期死亡（<72小时）以及术前存在肾或肝功能不全的患者。
9例（39%）患者发生术后急性肾损伤，第1组为22%（n = 2），第2组为50%（n = 7）（P = 0.183）。第1组在术后最初24小时尿量更高（P = 0.032）。11例患者在术后即刻出现肝功能受损：第1组2例（18.2%），第2组9例（81.8%）（P = 0.04）。在最初72小时内，双灌注组的国际标准化比值（P = 0.006 - 0.031）和凝血酶原时间（P = 0.007 - P = 0.016）显著更低。在最初72小时内乳酸水平存在显著差异（P = 0.001 - 0.009）。两组均无术后死亡病例。
选择性内脏灌注是一种安全的手术方法，可提供更好的尿量、肝功能和组织灌注。该技术允许在不进行深低温循环停搏的情况下修复新生儿复杂主动脉弓畸形。
