Selective antegrade cerebral perfusion (SACP), combined with continuous cardiopulmonary bypass (CPB), has become a widely accepted alternative to deep hypothermic circulatory arrest (DHCA). This technique ensures a continuous supply of oxygenated blood to the brain during aortic arch surgery, minimizing the risk of ischemic injury and improving neurological outcomes.
Methods
Retrospective data of all 36 patients undergoing aortic arch repair with selective antegrade cerebral perfusion between September 2020 to June 2024 was collected from hospital medical records. In addition to demographic details, intraoperative details, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, SACP time, additional procedures if any were recorded. In-hospital surgical outcomes including mortality and morbidity data were analysed.
Results
Between 2002 and 2024, 36 patients underwent aortic arch repair using selective antegrade cerebral perfusion. Median age was 1 month. The in-hospital mortality was 5.5%. (2/36). Stroke occurred in 5.5% (2/36), seizures in 11.1%, (4/36) and acute kidney injury in 16.6%. (6/36).Overall outcomes were favourable, with most neurological complications resolving fully and with no residual deficits.
Conclusion
SACP is a safe neuroprotective strategy for aortic arch surgery in congenital heart disease. Optimal flow rates and neuromonitoring minimize neurological complications. Larger studies are required to definitively establish SACP’s superiority over DHCA in these complex procedures.
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