Major complications and mortality
Our study generated very promising results concerning mortality (1.44%) and major complications, with only one case (1.44%) of neurological injury and two cases (2.89%) of transient renal failure requiring dialysis. No myocardial or visceral ischemic injuries were observed. Currently, aortic arch repair with or without VSD repair using median sternotomy and CPB is a well-mastered technique. Despite long CPB or circulatory arrest times in several cases, CCMSP at moderate hypothermic circulation was able to ensure good organ protection. Despite of the circulatory arrest of the lower part of the body, organ perfusion are ensured by multiple vascular communication through the selective cerebral perfusion. That’s why we clamp the descending aorta during the aortic arch reparation to avoid back flow. On note is that we do not perform systematic brain imaging after arch surgery, reserving imaging for children with clinical neurological disorders. Overall, our clinical results are very satisfactory. Concerning cerebral protection, Rüffer and colleagues demonstrated symmetrical perfusion of both cerebral hemispheres during ACP (17), while Algra and colleagues clearly illustrated how continuous cerebral perfusion during neonatal aortic arch surgery caused decreased circulatory arrest-induced renal and visceral injury (18). Comparing the two perfusion techniques performed at 18°C, the latter study reported that ACP was superior to DHCA in terms of abdominal perfusion, as confirmed by near-infrared spectroscopy data, postoperative inferior vena cava lactate levels, and renal and gastrointestinal injury biomarkers.