Equal cerebral perfusion during extended aortic coarctation repair

Rüffer A, Knieling F, Cesnjevar R, Regensburger A, Purbojo A, Dittrich S, Münch F, Wölfle J, Jüngert JM (2021)

Publication Type: Journal article

Publication year: 2021

Journal

European Journal of Cardio-Thoracic Surgery Oxford University Press

Book Volume: 61

Pages Range: 299-306

Journal Issue: 2

DOI: 10.1093/ejcts/ezab415

Abstract

OBJECTIVES: Aortic coarctation with distal aortic arch hypoplasia can be effectively addressed by coarctation resection with extended end-to-end-anastomosis (REEEA). Particularly, when unilateral cerebral perfusion (UCP) is established by clamping of left-sided supra-aortic vessels, the extent of cerebral blood flow distribution during repair remains undetermined, so far. Transfontanellar contrast-enhanced ultrasound (T-CEUS) can be utilized for real-time visualization and quantitative evaluation of cerebral blood flow. This study quantitatively evaluates cerebral perfusion during REEEA by using intraoperative T-CEUS. METHODS: In a prospective study, 9 infants with open fontanelle undergoing REEEA [median age: 13 days (range 1-34) and median weight 3.1 kg (range 2.2-4.4)] were intraoperatively examined with T-CEUS at 3 consecutive time-points: before skin incision, during UCP and after skin suture. A software-based analysis of 11 parameters was used for data evaluation. Absolute and relative blood flow in contralateral hemispheres was measured in side-by-side comparison, and referenced to baseline measurements. RESULTS: No side-depend absolute or relative cerebral perfusion differences were found during REEEA, except for an increased relative 'wash-out-rate' (P = 0.0013) in favour of the right hemisphere after surgery. Compared to ipsilateral baseline levels, 'rise time' was transiently increased in right (P = 0.0277) and 'time-to-peak' in both hemispheres (right: P = 0.0403 and left: P = 0.0286), all during UCP. CONCLUSIONS: The use of T-CEUS provided evidence for homogenous distribution of contrast agent in both hemispheres during UCP. T-CEUS can be utilized for the postprocedural evaluation of cerebral perfusion during congenital cardiac surgery. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov Unique, Identifier: NCT03215628.

Authors with CRIS profile

Ferdinand Knieling Department of Paediatrics and Adolescent Medicine Robert Cesnjevar Department of Paediatric Cardiac Surgery Adrian Regensburger Department of Paediatrics and Adolescent Medicine Ariawan Purbojo Department of Paediatric Cardiac Surgery Sven Dittrich Department of Paediatric Cardiology Frank Münch Department of Paediatric Cardiac Surgery Joachim Wölfle Lehrstuhl für Kinder- und Jugendmedizin

Involved external institutions

Universitätsklinikum Aachen (UKA) DE Germany (DE)

How to cite

APA:

Rüffer, A., Knieling, F., Cesnjevar, R., Regensburger, A., Purbojo, A., Dittrich, S.,... Jüngert, J.M. (2021). Equal cerebral perfusion during extended aortic coarctation repair. European Journal of Cardio-Thoracic Surgery, 61(2), 299-306. https://dx.doi.org/10.1093/ejcts/ezab415

MLA:

Rüffer, André, et al. "Equal cerebral perfusion during extended aortic coarctation repair." European Journal of Cardio-Thoracic Surgery 61.2 (2021): 299-306.

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