Pediatric Aortic Arch Reconstruction Using Sustained Total All-Region Perfusion (STAR): Early Experience and Postoperative Outcomes

BackgroundSustained total all-region (STAR) perfusion is an emerging technique that provides continuous perfusion to the brain, lower body, and heart with mild hypothermia. We hypothesized that using STAR perfusion would result in improved postoperative outcomes.MethodsThe 4 cohorts evaluated (total n = 105) included 1) STAR perfusion for aortic arch reconstruction (Arch w/ STAR), 2) STAR perfusion for aortic arch reconstruction with subsequent cardiac arrest for ventricular septal defect/atrial septal defect (VSD/ASD) (Arch/ASD/VSD w/ STAR), 3) hypothermic circulatory arrest (HCA) with cerebral perfusion (CP) for aortic arch reconstruction (Arch w/ HCA/CP), and 4) hypothermic circulatory arrest with cerebral perfusion for aortic arch reconstruction and VSD/ASD closure (Arch/ASD/VSD w/ HCA/CP). Primary outcomes were 1-year mortality and postoperative kidney, neurologic, and cardiac dysfunction.ResultsOperative times differed between the cohorts, with Arch w/ STAR patients having the lowest operative times. Peak postoperative lactate was lower in patients who underwent Arch w/ STAR compared with Arch w/ HCA/CP. On multivariable analysis, patients in the Arch w/ HCA/CP demonstrated higher peak postoperative lactate. Postoperative creatinine was primarily predicted by baseline renal function on multivariable analysis. Arch w/ STAR and Arch/ASD/VSD w/ STAR patients had a shorter time to chest closure, and Arch/ASD/VSD w/ STAR patients produced more urine at 24 h postoperative compared with patients who underwent Arch/ASD/VSD w/ HCA/CP. There were no differences in neurologic outcomes. No mortality occurred in our STAR cohorts.ConclusionSTAR perfusion is an emerging technique that is associated with lower peak lactate levels and shorter operative times compared with patients undergoing traditional methods of aortic reconstruction.