Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery

Background. Regional low-flow perfusion has been shown to provide cerebral circulatory support during neonatal aortic arch operations. However, its ab ility to provide somatic circulatory support remains unknown. Methods. Fifteen neonates undergoing arch reconstruction with regional perf usion were studied. Three techniques were used to assess somatic perfusion: abdominal aortic blood pressure, quadriceps blood flow (near-infrared spec troscopy), and gastric tonometry. Results. Twelve patients required operation for hypoplastic left heart synd rome, and 3 required arch reconstruction with a biventricular repair. There was one death (7%). Abdominal aortic blood pressure was higher (12 +/- 3 m in Hg versus 0 +/- 0 min Hg), and quadriceps blood volumes (5 +/- 24 versus -17 +/- 26) and oxygen saturations (57 +/- 25 versus 33 +/- 12) were great er during regional perfusion than during deep hypothermic circulatory arres t (p < 0.05). During rewarming, the arterial-gastric mucosal carbon dioxide tension difference was lower after circulatory arrest than after regional perfusion (-3.3 +/- 0.3 min Hg versus 7.8 +/- 7.6 mm Hg, p < 0.05). Conclusions. Regional low-flow perfusion provides somatic circulatory suppo rt during neonatal arch surgical procedures. Support of the subdiaphragmati c viscera should improve the ability of neonates to survive the postoperati ve period. (C) 2001 by The Society of Thoracic Surgeons.