Pitfalls in neonatal cardiac surgery using antegrade cerebral perfusion


In the past decade, advances in the surgical management of children with severe congenital heart disease (CHD) have led to a dramatic improvement in survival. The greatest impact of these advances has been on neonates with complex, and what previously would have been lethal, heart disease. However, there are an increasing number of reports on adverse neurologic outcomes in neonates and infants after this kind of operation, ranging from mild neuropsychologic deficits, detectable only by means of sensitive tests, to gross damage, resulting in persisting vegetative state or death.1 , 2 , 3 The awareness that improved survival comes at the cost of substantial neurologic morbidity has been an incentive for extensive research in this field. Some lifesaving surgical procedures are impossible without deep hypothermic circulatory arrest (DHCA), but this procedure has been linked with neurologic sequelae. Although the duration of “safe DHCA” remains unknown, adverse outcomes are more frequently observed in children with a DHCA duration exceeding 45 minutes.4 Various strategies for preventing neurologic problems and allowing the surgeon more time for optimal repair and hemostasis have been developed. One of the most promising is low-flow antegrade cerebral perfusion (ACP).5 This technique has been successfully applied in adults and is being introduced in neonatal aortic surgery.

Journal of Thoracic and Cardiovascular Surgery