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.