Neurological Injury After Neonatal Cardiac Surgery: A Randomized, Controlled Trial of 2 Perfusion Techniques
Abstract
Background—: Complex neonatal cardiac surgery is associated with cerebral injury. In particular, aortic arch repair, requiring either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP), entails a high risk of perioperative injury. It is unknown whether ACP results in less cerebral injury than DHCA. Methods and Results—: Thirty-seven neonates with an aortic arch obstruction presenting for univentricular or biventricular repair were randomized to either DHCA or ACP. Preoperatively and 1 week after surgery, magnetic resonance imaging was performed in 36 patients (1 patient died during the hospital stay). The presence of new postoperative cerebral injury was scored, and results were entered into a sequential analysis, which allows for immediate data analysis. After the 36th patient, it was clear that there was no difference between DHCA and ACP in terms of new cerebral injury. Preoperatively, 50% of patients had evidence of cerebral injury. Postoperatively, 14 of 18 DHCA patients (78%) had new injury versus 13 of 18 ACP patients (72%) ( P =0.66). White matter injury was the most common type of injury in both groups, but central infarctions occurred exclusively after ACP (0 vs 6/18 [33%]; P =0.02). Early motor and cognitive outcomes at 24 months were assessed and were similar between groups ( P =0.28 and P =0.25, respectively). Additional analysis revealed lower postoperative arterial P co 2 as a risk factor for new white matter injury ( P =0.04). Conclusions—: In this group of neonates undergoing complex cardiac surgery, we were unable to demonstrate a difference in the incidence of perioperative cerebral injury after ACP compared with DHCA. Both techniques resulted in a high incidence of new white matter injury, with central infarctions occurring exclusively after ACP. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01032876.
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Postoperative white matter injury is associated with lower mean blood pressures.
“Postoperative WMI is associated with lower mean blood-pressures.71,74,81”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [81]
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“73.29 ± 16.11 NA Preoperative SBP (mmHg) 98.57 ± 11.63 NA Preoperative DBP (mmHg) 57.57 ± 9.74 NA Preoperative pH 7.34 ± 0.03 NA CPB time (min) 61.75 ± 7.52 NA AO time (min) 38.52 ± 5.38 NA Mean ± SD. TOF, tetralogy of Fallot; HC, healthy children; SpO2, saturation of pulse oxygen; SBP, systolic blood pressure; DBP, d…”
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Self-citation
- Authors
- Algra, S. O., Jansen, N. J. G., van der Tweel, I., Schouten, A. N. J., Groenendaal, F., Toet, M., van Oeveren, W., van Haastert, I. C., Schoof, P. H., de Vries, L. S., & Haas, F.
- Affiliations
- University Medical Center Utrecht (NL)
- From the Departments of Pediatric Cardiothoracic Surgery (S.O.A., P.H.S., F.H.), Pediatric Intensive Care (N.J.G.J.), Biostatistics (I.v.d.T.), Anesthesiology (A.N.J.S.), and Intensive Care and Emergency Medicine, Neonatology (F.G., M.T., I.C.v.H., L.S.d.V.), University Medical Center Utrecht, Utrecht, The Netherlands; and HaemoScan, Groningen, The Netherlands (W.v.O.).
- Venue
- Circulation
- Published
- 2014-01-14
- Volume
- 129
- Issue
- 2
- Pages
- 224-233
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2039622325
- Cited by
- 163
- References
- 33
- Citations by year
- 2026: 13 · 2025: 7 · 2024: 14 · 2023: 11 · 2022: 15 · 2021: 16 · 2020: 24 · 2019: 15 · 2018: 13 · 2017: 16 · 2016: 13 · 2015: 4 · 2014: 2
- FWCI
- 4.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- neonatal cardiac surgery, cerebral injury, deep hypothermic circulatory arrest, antegrade cerebral perfusion, aortic arch obstruction, white matter injury, arterial PCO2, univentricular repair
- MeSH terms
- Aorta, Thoracic, Brain, Brain Injuries, Cognition, Female, Cardiac Surgical Procedures, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Motor Activity, Perfusion, Incidence, Treatment Outcome, Circulatory Arrest, Deep Hypothermia Induced
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