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Is unilateral brain regional perfusion neurologically safe during congenital aortic arch surgery?

^a Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
^b Department of Anesthesiology, Seoul National University Children's Hospital, Seoul, Republic of Korea
^c Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea

Received 27 May 2007; received in revised form 15 July 2007; accepted 6 August 2007.

^_* Corresponding author. Address: Department of Thoracic & Cardiovascular Surgery, Seoul National University, College of Medicine, Seoul National University Children's Hospital, 28 Yongon-Dong, Jongno-Gu, Seoul 110-744, Republic of Korea. Tel.: +82 2 2072 3637; fax: +82 2 3672 3637. (Email: woonghan{at}snu.ac.kr).

Objective: This study was conducted to demonstrate that unilateral brain regional perfusion during congenital aortic arch anomaly surgery is neurologically safe. Methods: Fifteen patients who were diagnosed with congenital aortic arch anomaly between June 2004 and May 2006 were enrolled in this study. The mean age and body weight of the enrolled patients were 40.3 ± 35.9 days and 3.7 ± 1.0 kg, respectively. Underlying diseases included coarctation of the aorta (12) and an interrupted aortic arch (3). The pre- and postoperative neurological state of each patient was evaluated by a neurologist using an electroencephalogram and brain SPECT. During the operation, unilateral brain regional perfusion was performed using innominate arterial cannulation. Near-infrared spectroscopy (NIRS) and transcranial Doppler ultrasonographic evaluation of the cerebral artery was used to monitor the cerebral perfusion state during surgery. After being discharged a neurologist conducted regular follow-up evaluations of the patients to monitor their neurological development. Results: There were no operative mortalities. Based on NIRS data, there were no significant differences between left and right oxygen saturation during regional perfusion (left:right = 66.0 ± 10.4%:69.8 ± 1.0%, p = 0.72) or between the pre-regional and regional perfusion period (1. left side pre-regional perfusion:regional perfusion = 66.9 ± 11.8%:66.0 ± 10.4%, p = 0.92, 2. right side pre-regional perfusion:regional perfusion = 70.2 ± 11.1%:69.8 ± 10.0%, p = 0.96). Additionally, there were no differences between pre- and postoperative findings in EEG and brain SPECT. For 17.5 ± 9.0 months of follow-up duration, no patients showed abnormal neurological finding and development. Conclusions: Unilateral brain regional perfusion in neonates and children may be a useful technique with no significant neurological deficit.

Key Words: CHD • Great vessel anomalies • Aortic arch • Neurocognitive deficits