Background: Aortic arch reconstruction requiring cardiopulmonary bypass(CPB) is usually performed with circulatory arrest(CA) or selective cerebral perfusion at profound hypothermia(H-SCP). We describe outcomes of patients who underwent aortic arch reconstruction using only moderate hypothermia with selective cerebral perfusion(M-SCP).

Results: There were 54 patients(19 two-ventricle, 35 single-ventricle) identified. Single-ventricle(1V) diagnoses included: hypoplastic left heart syndrome(HLHS) or variant HLHS(N=24), unbalanced AV canal(N=5), DILV with arch hypoplasia(N=3), and DORV with mitral atresia and arch hypoplasia(N=3). Two-ventricle(2V) diagnoses included: coarctation of the aorta(CoA) with VSD(N=11), CoA with arch hypoplasia(N=4), interrupted aortic arch(IAA, N=3) and recurrent CoA late s/p IAA repair(N=1). Median age at surgery was 5 days(range, 1 day-10yrs) and median weight 3.2kg(2-32kg). There were 4 operative deaths in the 1V group(11.4%) and no deaths in the 2V group. There were no instances of multi-organ failure referable to renal, hepatic, gastrointestinal, or spinal cord injury in either group. Delayed sternal closure was performed in all of the 1V group and 2/19(10.5%) of the 2V group. Median intubation time was 4 days(range, 0.5-95d), median ICU stay was 8 days(range, 1-110d) and median hospital stay was 20 days(range, 3-177d) for the entire cohort. Median follow-up was 22.5 months(range, 9 mos-3.7yrs) with recurrent arch obstruction occurring in 2 patients(4%), both of whom were in the 1V group.

Conclusions: Aortic arch reconstruction with M-SCP is feasible and safe for 1V and 2V patients, with a low incidence of recurrent arch obstruction. Avoidance of prolonged cooling and rewarming using this technique may also reduce overall cardiopulmonary bypass support time.