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

Aim: When reconstructing the aortic arch (AA), it is necessary to select a method that provides optimal protection of the internal organs and the brain. It was previously believed that the hypothermic circulatory method was optimal. However, recently, the application of antegrade cerebral perfusion with moderate hypothermia has proved preferable when performing reconstructive operations on the aorta on adult patients and some children. In these instances, continuous cerebral perfusion reduces the incidence of neurological complications. However, the degree of damage to the organ systems distal to the AA remains unclear. The objective of this study was to assess the effectiveness and safety of various methods for protecting the brain and internal organs during reconstructive operations on the AA in small children.

Material and Methods: A retrospective analysis of 60 patients who had received reconstructive operations on the AA was undertaken. The neurological status and the degree of damage to internal organs in the short- and long-term, combined with the application of various methods for protecting the brain, were assessed. Surgical correction of the congenital pathology of the AA under deep hypothermic circulatory arrest conditions was performed in 26 patients (Group I) and antegrade unilateral selective perfusion of the brain was used for 34 patients (Group II).

Conclusion: Nervous system complications were detected in 28.5% of patients in Group I, whereas it affected 7.9% of patients in Group II. Thus, the odds ratio for development of the neurological case was significantly lower for Group II: 0.17 (0.06–0.69), p = 0.02. However, in this Group, patients with renal dysfunction equated to 58.7%, whereas this figure was 23.7% for Group I, p = 0.02.