A 6-Year Single Center Experience in Neonatal Aortic Arch Surgery with Whole-Body Perfusion: Showing the Perks by Strict Propensity Score Matching

TL;DR

This study shows that Whole-Body Perfusion improves outcomes in neonatal aortic arch surgery compared to traditional methods.

Contribution

The study introduces Whole-Body Perfusion as a superior perfusion strategy in neonatal aortic arch surgery, validated through strict propensity score matching.

Findings

Whole-Body Perfusion reduced time on cardiopulmonary bypass and cross-clamp significantly.

Patients with Whole-Body Perfusion required fewer blood transfusions and had shorter ventilator times.

Lactate levels and signs of multiorgan dysfunction were lower in Whole-Body Perfusion patients.

Abstract

Objectives: Perfusion strategy is crucial for the outcome of neonatal aortic arch surgery. This study investigates Whole-Body Perfusion to potentially improve postoperative outcomes for neonates, addressing a significant gap in current research. Methods: Retrospective analysis was conducted for neonates receiving aortic arch reconstruction in our institution: 33 patients were treated with Antegrade Cerebral Perfusion (ACP, 2014–2017) and 61 patients with Whole-Body Perfusion (WBP, 2017–2022). After strict Propensity Score Matching, 20 patients were analyzed in each group. WBP consists of ACP and Lower Body Perfusion (LBP), achieved through a femoral arterial sheath. Results: Patients with WBP had a shorter time on Cardiopulmonary Bypass (86.65 ± 25.47 vs. 172.95 ± 60.12 min) and Cross-Clamp time (46.70 ± 18.48 vs. 91.30 ± 40.10 min) (p ≤ 0.001). Lactate at the time of reperfusion and after 24 h was lower in the WBP group (1.73 ± 0.63 vs. 4.29 ± 1.61, p < 0.001; 1.45 ± 0.57 vs. 2.09 ± 0.96 mmol/L, p = 0.026). Patients with WBP needed significantly fewer intraoperative transfusions of Red Blood Cells, Fresh Frozen Plasma and Platelets (p ≤ 0.001). WBP patients had a shorter time on ventilator (5.15 ± 4.05 vs. 10.00 ± 8.72 days, p = 0.01) and a higher urine output after 24 h (200.85 ± 100.87 vs. 118.10 ± 82.33 mL, p = 0.002). Conclusions: Patients treated with WBP received significantly fewer intraoperative transfusions and had a shorter time on extracorporeal circulation and ventilator. Furthermore, there was a trend for reduced multiorgan dysfunction.

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