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

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.