Sandoval Boburg Rodrigo, Doll Isabelle, Rustenbach Christian Jörg, Berger Rafal, Jost Walter, Magunia Harry, Nordmeyer Johannes, Michel Jörg, Schlensak Christian
Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
J Clin Med. 2024 Oct 16;13(20):6170. doi: 10.3390/jcm13206170.
Neonatal aortic arch surgery remains one of the most challenging procedures in congenital cardiac surgery. In recent years, there has been a trend away from selective cerebral perfusion (SCP) and arrest of body circulation towards whole-body perfusion (WBP), a combination of SCP and lower-body perfusion (LBP), to facilitate arch surgery and preserve organ function. Retrospective, single-centre analysis was conducted of patients under one year of age undergoing aortic arch surgery from January 2014 until December 2022. SCP was used from January 2014-December 2017; WBP was implemented from January 2017-December 2022. Patients were separated according to the type of perfusion used during surgery, SCP or WBP. The cohort consisted of a total of 95 patients, 34 in the SCP group and 61 in the WBP group. Patients in the WBP group showed significantly lower rates of intraoperative transfusions, namely red blood cells, fresh-frozen plasma and thrombocytes (-value < 0.01, <0.01, and <0.01, respectively). The WBP group showed significantly lower creatinine and higher urine output values 24 and 72 h after surgery (-value = 0.02, <0.01, respectively). The WBP group showed a significant lower incidence of major neurological complications (-value 0.01). Binary logistic regression analyses showed favourable outcomes for the WBP group regarding 30-day mortality (OR = 0.03, CI = 0.003-0.391, -value = <0.01), multiorgan failure (OR = 0.002, CI = 0-0.275, -value = 0.01), neurological complications (OR = 0.994, CI = 0.998-1, -value = 0.06) and postoperative renal replacement therapy (RRT) (OR = 0.989, CI = 0.983-0.995, -value = <0.01). Patients with WBP received fewer intraoperative transfusions, showed improved postoperative renal function and suffered significantly fewer neurological complications.
新生儿主动脉弓手术仍然是先天性心脏手术中最具挑战性的手术之一。近年来，出现了一种趋势，即从选择性脑灌注（SCP）和体循环停搏转向全身灌注（WBP）、SCP与下半身灌注（LBP）相结合，以促进主动脉弓手术并保护器官功能。对2014年1月至2022年12月期间接受主动脉弓手术的1岁以下患者进行了回顾性单中心分析。2014年1月至2017年12月使用SCP；2017年1月至2022年12月实施WBP。根据手术期间使用的灌注类型（SCP或WBP）对患者进行分组。该队列共有95例患者，SCP组34例，WBP组61例。WBP组患者术中输血率显著较低，即红细胞、新鲜冰冻血浆和血小板（P值分别<0.01、<0.01和<0.01）。WBP组术后24小时和72小时的肌酐值显著较低，尿量较高（P值分别为0.02、<0.01）。WBP组主要神经并发症的发生率显著较低（P值0.01）。二元逻辑回归分析显示，WBP组在30天死亡率（OR = 0.03，CI = 0.003 - 0.391，P值 = <0.01）、多器官功能衰竭（OR = 0.002，CI = 0 - 0.275，P值 = 0.01）、神经并发症（OR = 0.994，CI = 0.998 - 1，P值 = 0.06）和术后肾脏替代治疗（RRT）（OR = 0.989，CI = 0.983 - 0.995，P值 = <0.01）方面有良好的结果。接受WBP的患者术中输血较少，术后肾功能改善，神经并发症显著减少。
