Whole-Body Perfusion in Neonates and Infants Undergoing Aortic Arch Surgery-Working Towards the New Standard.

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.