[Neurological changes and outcomes of paediatric surgery of the aortic arch using selective cerebral perfusion]

An Pediatr (Engl Ed). 2020 Nov;93(5):305-312. doi: 10.1016/j.anpedi.2020.03.006. Epub 2020 Jun 6.
[Article in Spanish]

Abstract

Introduction: The aims of this article are to analyse the neuropsychological changes in the medium-term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement.

Material and methods: Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills.

Results: The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32ml/kg/min. The mean time of SCP was 31minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old.

Conclusions: Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development.

Keywords: Aortic arch; Avance aórtico; Cardiopatías congénitas; Congenital heart diseases; Desarrollo neurológico; Neurological development; Paediatrics; Pediatría; Perfusión cerebral selectiva; Selective cerebral perfusion.

MeSH terms

  • Aorta, Thoracic / surgery*
  • Aortic Diseases
  • Brain / blood supply*
  • Cerebrovascular Circulation / physiology*
  • Child
  • Child, Preschool
  • Humans
  • Infant