Impact Of Antegrade Cerebral Perfusion In Neonates And Infants Undergoing Circulatory Arrest: A Meta-analysis
David Blitzer, David Blitzer, Jamie Harrington, Tarif Chaudhury, Nimrod Goldstrom, Michael Brewer, Stephanie Levasseur, Emile Bacha, David Kalfa.
Columbia University, New York, NY, USA.
Objectives: The impact of antegrade cerebral perfusion (ACP) in neonates and infants remains controversial. This meta-analysis aims to compare neurological events and neurodevelopmental outcomes between ACP and deep hypothermic circulatory arrest (DHCA) alone. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched for articles comparing outcomes between ACP and DHCA alone in neonates and infants undergoing cardiac surgery. The primary endpoints were clinical seizures, neurological events and developmental scores. The secondary outcome was in-hospital mortality. This meta-analysis was performed according to the PRISMA guidelines. Results: Nine studies were included with 2401 patients (ACP: 894 and no ACP: 1507). Seven studies included neonates with a majority of males (62%). Additionally, most patients had a hypoplastic left heart syndrome (72%). There was no difference in sex, age, weight and main congenital diagnosis between the ACP and DHCA alone group. Neurological events and clinical seizures were lower in the ACP group (OR 0.32 [0.18, 0.55] and OR 0.25 [0.08, 0.80], p<0.001 and p=0.02 respectively) (Figure). The mental and psychomotor development indexes were similar between groups (SMD -0.08[-0.41;0.25] and -0.15[-0.48;0.18], p=0.65 and p=0.38 respectively). Finally, there was no difference in hospital mortality (OR 0.86[0.65;1.13], p=0.29). Conclusions: Antegrade cerebral perfusion was associated with a lower risk of postoperative clinical seizures and neurological events. There was no difference in mental and psychomotor development in up to 1 year after surgery.
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