ANALYSIS OF THE VISCERAL PERFUSION STRATEGIES DURING INFANT AORTIC ARCH RECONSTRUCTION

Aim To compare the effects of continuous regional perfusion methods for infant aortic arch repair on the incidence of acute renal dysfunction and mortality in the early postoperative period.

Methods A total of 121 infants who underwent aortic arch reconstruction in the period from June 2007 to December 2017 were included in the study. Patients were 1:1 propensity score matched using the nearest-neighbor methodology. Sixty-two patients (median age 14 (interquartile range (IQR) [8; 23]) days) were selected for the retrospective analysis and divided in two groups: those who underwent repair with selective antegrade cerebral perfusion (SACP) (SACP group, 31 patients) at 23–26°C and those who received whole brain perfusion and additional lower body perfusion (double arterial cannulation (DAC) group, 31 patients) at 28–32°C.

Results In-hospital mortality was 3.2% in the DAC group (3.2%) and 12.8% in the SACP group, respectively (p = 0.03). More patients from the SACP group required an open chest after operation (p = 0.013). Patients from the DAC group had shorter open chest duration (p = 0.002) and shorter length of stay in the intensive care unit (ICU) (p = 0.035). There were no differences in the need for renal replacement therapy (p = 0.20) and rate of creatinine level progression during the first three postoperative days between the groups (p = 0.53). The body mass of less than 2 kilos predisposes patients to the onset of acute renal dysfunction (p = 0.013), which was found to be a predictor of early mortality (p = 0.038).

Conclusion Lower body perfusion reported similar results to SACP in terms of the onset of acute renal dysfunction, but was superior in terms of lower mortality and shorter lengths of stay in the ICU.

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