The risk of renal and neurological complications after reconstructive surgery of the aortic arch in newborns

Abstract

When reconstructing the aortic arch (AA), it is necessary to select a method\nthat provides optimal protection of the internal organs and the brain. It was\npreviously believed that the hypothermic circulatory method was optimal.\nHowever, recently, the application of antegrade cerebral perfusion with moderate\nhypothermia has proved preferable when performing reconstructive operations\non the aorta on adult patients and some children. In these instances, continuous\ncerebral perfusion reduces the incidence of neurological complications. However,\nthe degree of damage to the organ systems distal to the AA remains unclear.The\nobjective of this study was to assess the effectiveness and safety of various methods\nfor protecting the brain and internal organs during reconstructive operations\non the AA in small children. A retrospective analysis of 60 patients who had\nreceived reconstructive operations on the AA was undertaken. The neurological\nstatus and the degree of damage to internal organs in the short- and long-term,\ncombined with the application of various methods for protecting the brain, were\nassessed. Surgical correction of the congenital pathology of the AA under deep\nhypothermic circulatory arrest conditions was performed in 26 patients (Group I)\nand antegrade unilateral selective perfusion of the brain was used for 34 patients\n(Group II). Nervous system complications were detected in 28.5% of patients in\nGroup I, whereas it affected 7.9% of patients in Group II. Thus, the odds ratio for\ndevelopment of the neurological case was signiϐicantly lower for Group II: 0.17\n(0.06–0.69), p = 0.02. However, in this Group, patients with renal dysfunction\nequated to 58.7%, whereas this ϐigure was 23.7% for Group I, p = 0.02