Application of selective cerebral perfusion in aortic arch reconstruction procedure in infants / 中华实用儿科临床杂志

ABSTRACT

Objective To summarize the cerebral protective effect of selective cerebral perfusion (SCP) technique in aortic arch reconstruction procedure in infants,so as to alleviate brain injury during operation.Methods From Sep.2009 to Sep.2011,17 infants underwent aortic arch reconstruction procedure with SCP in Children's Hospital Affiliated to Fudan University.Median age at operation was (3.5 ±4.2) months(range 1-16 months),median weight was (4.6 ± 1.5) kg(range 3.5-9.5 kg).Seven suffered from interrupted aortic with intracardiac anomaly,and 10 suffered from aortic coarctation with intracardiac anomaly.Temperature of nasopharynx was decreased slowly to 18-20 ℃,temperature of rectum was decreased slowly to 20-22 ℃.Then the arterial cannula was moved upward into innominate artery to perform SCP.The flow rate of SCP was 30-40 mL/(kg · min).Myocardial protection was established with single-dose cold constable's protection fluid (HTK solution).During extracorporeal circulation,all patients underwent conventional ultrafiltration and modified ultrafiltration to achieve a satisfactory hematocrit.Results Mean extracorporeal circulation time was (113.1 ±36.5) minutes(71-190 minutes),mean aortic clamp time was (51.9 ±20.7) minutes (34-107 minutes),and mean SCP time was (24.0 ± 19.7) minutes (4-56 minutes).The spontaneous re-beating rate was 100％.Mean regain consciousness time was 6-8 hours.Mean intubation time in intensive care unit was (164.3 ±63.2) hours(22-305 hours),mean ICU stay time was (252.7 ± 128.3) hours(72-605 hours).One infant died from serious lung infection at the 12th day after operation.There was no neurological complication in all infants.No obvious neurologic complication was observed and no abnormal electroencephalogram was observed in 16 survivals.Conclusion SCP is helpful to alleviate brain injury during operation and it is a feasible and effective technique in aortic arch reconstruction procedure in infants.