Markers of peripheral perfusion during high-flow regional cerebral perfusion for aortic arch repair

Abstract

Objectives: High-flow regional cerebral perfusion (HFRCP) provides cerebral and somatic oxygen delivery through collateral vessels during aortic arch repair in small children; however, optimal flow conditions during HFRCP have not been established. We sought to identify markers of peripheral perfusion during HFRCP.

Methods: Between 2009 and 2016, in total 20 consecutive pediatric patients undergoing aortic arch repair with HFRCP were enrolled in this prospective, observational study. Median age was 20 days (range, 6-116 days); median body weight was 2.77 kg (range, 1.8-4.98 kg). Oxygen delivery ratio (Do₂R) was calculated as the oxygen delivery during HFRCP divided by the oxygen delivery before HFRCP. Regional oxygen saturations on the forehead and on the thigh (rSo₂T) were monitored during HFRCP, and postoperative creatinine kinase and lactate concentrations were measured as postoperative outcomes. Multivariate analyses were performed to clarify the effectiveness of Do₂R and rSo₂T as markers of peripheral perfusion during HFRCP.

Results: No deaths or neurologic impairments occurred. Multivariate analysis showed that the lowest rSo₂T (P = .005) and cardiopulmonary bypass time (P = .012) predicted postoperative creatinine kinase concentration. Do₂R was the only factor to predict postoperative lactate concentration (P < .001). Receiver operating characteristic analysis showed that Do₂R less than 0.66 predicted risk of high postoperative lactate concentration (>5.0 mmol/L), with area under the curve of 0.95.

Conclusions: For aortic arch repair in small children, rSo₂T and Do₂R during HFRCP are useful markers for predicting peripheral perfusion. Maintaining higher Do₂R during HFRCP minimizes postoperative increases in lactate and creatinine kinase concentrations.

Keywords: arch repair; congenital; neonate; regional cerebral perfusion.