Vol. 30 No. 1 (2026)
ANESTHESIOLOGY & RESUSCITATION

Ten years of experience with total perfusion for cerebral and end-organ protection during aortic arch reconstruction in neonates

pdf (Русский) pdf html (Русский)
  • Ilya A. Velukhanov,
  • Ekaterina N. Amansakhatova,
  • Ilya V. Bondarenko,
  • Olga S. Anikina,
  • Yuriy Yu. Kulyabin,
  • Alexey N. Arkhipov,
  • Alexey V. Voitov,
  • Victor Y. Martynenkov,
  • Valery A. Nepomnyashchy,
  • Igor A. Kornilov,
  • Ilya A. Soynov
Ilya A. Velukhanov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Ekaterina N. Amansakhatova
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Ilya V. Bondarenko
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Olga S. Anikina
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Yuriy Yu. Kulyabin
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Alexey N. Arkhipov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Alexey V. Voitov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Victor Y. Martynenkov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Valery A. Nepomnyashchy
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
Igor A. Kornilov
Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, USA
Ilya A. Soynov
Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2026-1-90-98

Published 2026-04-14

Keywords

  • aortic coarctation; congenital heart defect; fullflow perfusion; neurological dysfunction; renal dysfunction

How to Cite

Velukhanov, I. A. ., Amansakhatova, E. N. ., Bondarenko, I. V. ., Anikina, O. S. ., Kulyabin, Y. Y. ., Arkhipov, A. N. ., Voitov, A. V. V., Martynenkov, V. Y. ., Nepomnyashchy, V. A. ., Kornilov, I. A. ., & Soynov, I. A. . (2026). Ten years of experience with total perfusion for cerebral and end-organ protection during aortic arch reconstruction in neonates. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 30(1), 90–98. https://doi.org/10.21688/1681-3472-2026-1-90-98

Copyright (c) 2026 Velukhanov et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Introduction. Whole-body perfusion represents a promising alternative to traditional methods, such as deep hypothermic circulatory arrest and antegrade cerebral perfusion, potentially reducing the risks of both neurological complications and acute kidney injury. However, the experience with its application, especially in the most vulnerable group of neonates, remains insufficiently studied and requires systematic analysis of intraoperative and longterm outcomes.

Objective. To evaluate intraoperative and early postoperative outcomes in neonates undergoing aortic arch reconstruction with whole-body perfusion.

Methods. This prospective cohort study evaluated the efficacy and safety of surgical treatment in neonates undergoing aortic arch reconstruction with total perfusion (n = 43). The median patient age was 8 (IQR 5–28) days, and median body weight was 3.4 (IQR 2.9–4) kg. Male patients predominated 25 (58.2 %).

Results. The primary endpoint was acute kidney injury assessed using the pediatric KDIGO criteria. Acute kidney injury was observed in 9 (21 %) of patients. The only significant factor for acute kidney injury was the inotropic index on postoperative day 1 (OR = 1.08; 95 % CI (1.01; 1.17)). Neurological complications occurred in 4 (9.3 %) of patients. Hospital mortality was 1 (2.3 %).

Conclusion. Whole-body perfusion represents a straightforward, efficacious, and safe organ protection strategy for neonatal aortic arch reconstruction, demonstrating a low rate of acute kidney injury.

Received 25 August 2025. Revised 21 November 2025. Accepted 17 December 2025.

Informed consent

The patient’s official representative has provided informed consent for the use of the recordings for medical purposes.

Funding

The research was carried out within the framework of the state assignment of the Ministry of Health of the Russian Federation (No. 124022500251-0).

Conflict of interest

The authors declare no conflict of interest.

Сontribution of the authors

Conception and study design: I.A. Velukhanov, I.V. Bondarenko, O.S. Anikina, A.N. Arkhipov, I.A. Soynov

Data collection and analysis: I.A. Velukhanov, I.V. Bondarenko, O.S. Anikina

Statistical analysis: I.V. Bondarenko, Yu.Yu. Kulyabin, V.Y. Martynenkov, V.A. Nepomnyashchy

Drafting the article: I.A. Velukhanov, E.N. Amansakhatova, A.V. Voitov, I.A. Soynov

Critical revision of the article: E.N. Amansakhatova, O.S. Anikina, A.N. Arkhipov, I.A. Kornilov, I.A. Soynov

Final approval of the version to be published: all authors

pdf (Русский) pdf html (Русский)

References

  1. Kulyabin Y.Y., Bogachev-Prokophiev A.V., Soynov I.A., Omelchenko A.Y., Zubritskiy A.V., Gorbatykh Y.N. Clinical Assessment of Perfusion Techniques During Surgical Repair of Coarctation of Aorta With Aortic Arch Hypoplasia in Neonates: A Pilot Prospective Randomized Study. Semin Thorac Cardiovasc Surg. 2020;32(4):860-871. PMID: 32446921. https://doi.org/10.1053/j.semtcvs.2020.04.015
  2. Cheng M., Xu H.Z., Zhang K.J., Peng X.L., Pan Z.X., Hu, Y. Risk Factors of Perioperative Brain Injury in Children Under Two Years Undergoing Coarctation Repair. Pediatr Neurol. 2023;141:109-117. PMID: 36812697. https://doi.org/10.1016/j.pediatrneurol.2023.01.007
  3. Zajonz T.S., Edinger F., Beran R., Sturm N., Yoerueker U., Akintuerk H., Mueller M.F. Perioperative Incidence of Acute Renal Failure in Aortic Arch Reconstruction Using Retrograde Selective Lower Body Perfusion in Neonates and Infants. J Cardiothorac Vasc Anesth. 2025;39(7):1738-1745. PMID: 40221235. https://doi.org/10.1053/j.jvca.2025.03.028
  4. Kornilov I.A., Sinelnikov Y.S., Soinov I.A., Ponomarev D.N., Kshanovskaya M.S., Krivoshapkina A.A., Gorbatykh A.V., Omelchenko A.Y. Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion. Eur J Cardiothorac Surg. 2015;48(3): e45-50. PMID: 26141543. https://doi.org/10.1093/ejcts/ezv235
  5. Imoto Y., Kado H., Shiokawa Y., Minami K., Yasui H. Experience with the Norwood procedure without circulatory arrest. J Thorac Cardiovasc Surg. 2001;122(5):879-82. PMID: 11689791. https://doi.org/10.1067/mtc.2001.116948
  6. Сергеев С.А., Ломиворотов В.В. Острое повреждение почек у детей после кардиохирургических вмешательств. Патология кровообращения и кардиохирургия. 2021;25(4):11-22. http://dx.doi.org/10.21688/1681-3472-2021-4-11-22 Sergeev S.A., Lomivorotov V.V. Acute kidney injury after cardiac surgery in children. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2021;25(4):11-22. (In Russ.) http://dx.doi.org/10.21688/1681-3472-2021-4-11-22
  7. Soynov I.A., Gorbatikh Y.N., Kulyabin Y.Y., Manukian S.N., Rzaeva K.A., Velyukhanov I.A., Nichay N.R., Kornilov I.A., Arkhipov A.N. Evaluation of end-organ protection in newborns and infants after surgery of aortic arch hypoplasia: A prospective randomized study. Perfusion. 2025;40(4):1013-1022. PMID: 39177467. https://doi.org/10.1177/02676591241276980
  8. Kılıç Y., Selçuk A., Korun O., Ceyda H., Çiçek M., Yurdakök O., Altın F., Erdem H., Aydemir N.A., Şaşmazel A. Comparison of cases with and without additional lower body perfusion in newborns undergoing aortic arch reconstruction with antegrade selective cerebral perfusion method. Turk Gogus Kalp Damar Cerrahisi Derg. 2022;30(2):192-198. PMID: 36168563; PMCID: PMC9473591. https://doi.org/10.5606/tgkdc.dergisi.2022.22805
  9. Gaies M.G., Gurney J.G., Yen A.H., Napoli M.L., Gajarski R.J., Ohye R.G., Charpie J.R., Hirsch J.C. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234-8. PMID: 19794327. https://doi.org/10.1097/PCC.0b013e3181b806fc
  10. Belletti A., Lerose C.C., Zangrillo A., Landoni G. Vasoactive-Inotropic Score: Evolution, Clinical Utility, and Pitfalls. J Cardiothorac Vasc Anesth. 2021;35(10):3067-3077. PMID: 33069558. https://doi.org/10.1053/j.jvca.2020.09.117
  11. Patel R.M., Ferguson J., McElroy S.J., Khashu M., Caplan M.S. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020;88(Suppl 1):10-15. PMID: 32855506; PMCID: PMC8096612. https://doi.org/10.1038/s41390-020-1074-4
  12. Soynov I.A., Rzayeva K.A., Gorbatykh Y.N., Kulyabin Y.Y., Gorbatykh A.V., Velyukhanov I.A., Nichay N.R., Manukian S.N., Magbulova S.A., Arkhipov A.N., Bogachev-Prokophiev A.V. Comparison of Sternotomy Access Versus Thoracotomy Access in the Surgical Treatment of Aortic Coarctation: A Propensity Scorematched Study. J Saudi Heart Assoc. 2024;36(3):305-315. PMID: 39497699; PMCID: PMC11534338. https://doi.org/10.37616/2212-5043.1396
  13. Tulzer A., Mair R., Kreuzer M., Tulzer G. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg. 2016;152(6):1506-1513.e1. PMID: 27692955. https://doi.org/10.1016/j.jtcvs.2016.08.029
  14. Сойнов И.А., Горбатых Ю.Н., Рзаева К.А., Кулябин Ю.Ю., Ничай Н.Р., Войтов А.В., Велюханов И.А., Архипов А.Н., Богачев-Прокофьев А.В., Чернявский А.М. Анализ результатов коррекции коарктации с гипоплазией дуги аорты: «ascending sliding» против пластики дуги аорты заплатой из легочного гомографта. Сибирский журнал клинической и экспериментальной медицины. 2024;39(2):122-132. https://doi.org/10.29001/2073-8552-2022-625 Soynov I.A., GorbatykhYu.N., Rzaeva K.A., KulyabinYu.Y., Nichay N.R., Voitov A.V., Velyukhanov I.A., Arkhipov A.N.,ogachev-Prokophiev A.V., Chernyavsky A.M. Results of correction of coarctation with hypoplasia of the aortic arch: “ascending sliding” against plasty of the aortic arch with a patch from the pulmonary homograph. Siberian Journal of Clinical and Experimental Medicine. 2024;39(2):122-132. (In Russ.) https://doi.org/10.29001/2073-8552-2022-625
  15. Gocoł R., Hudziak D., Bis J., Mendrala K., Morkisz Ł., Podsiadło P., Kosiński S., Piątek J., Darocha T. The Role of Deep Hypothermia in Cardiac Surgery. Int J Environ Res Public Health. 2021;18(13):7061. PMID: 34280995; PMCID: PMC8297075. https://doi.org/10.3390/ijerph18137061
  16. Hughes G.C., Chen E.P., Browndyke J.N., Szeto W.Y., DiMaio J.M., Brinkman W.T., Gaca J.G., Blumenthal J.A., Karhausen J.A., Bisanar T., James M.L., Yanez D., Li Y.J., Mathew J.P. Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest Trial (GOT ICE): A Randomized Clinical Trial Comparing Outcomes After Aortic Arch Surgery. Circulation. 2024;149(9):658-668. PMID: 38084590; PMCID: PMC10922813. https://doi.org/10.1161/CIRCULATIONAHA.123.067022
  17. Alkhatip A.A.A.M.M., Kamel M.G., Farag E.M., Elayashy M., Farag A., Yassin H.M., Bahr M.H., Abdelhaq M., Sallam A., Kamal A.M., Emady M.F.E., Wagih M., Naguib A.A., Helmy M., Algameel H.Z., Abdelkader M., Mohamed H., Younis M., Purcell A., Elramely M., Hamza M.K. Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing Cardiac Surgery With Electroencephalography Monitoring: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021;35(10):2875-2888. PMID: 33637420. https://doi.org/10.1053/j.jvca.2021.01.039
  18. McCullough J.N., Zhang N., Reich D.L., Juvonen T.S., Klein J.J., Spielvogel D., Ergin M.A., Griepp R.B. Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg. 1999;67(6):1895-9; discussion 1919-21. PMID: 10391334. https://doi.org/10.1016/s0003-4975(99)00441-5
  19. Rybar D. Deep Hypothermic Circulatory Arrest: A Brief History and Where It Is Going. J Cardiothorac Vasc Anesth. 2024;38(2):560-562. PMID: 38228425. https://doi.org/10.1053/j.jvca.2023.11.010
  20. Синельников Ю.С., Гасанов Э.Н., Сойнов И.А., Мирзазаде Ф.А. Фатальные почечные и неврологические осложнения после реконструкции дуги аорты у новорожденных. Хирургия. Журнал им. Н.И. Пирогова. 2018;(6):77‑82. https://doi.org/10.17116/hirurgia2018677-82 Sinelnikov Yu.S., Gasanov E.N., Soynov I.A., Mirzazade F.A. Fatal renal and neurological complications after aortic arch repair in newborns. Pirogov Russian Journal of Surgery. 2018;(6):77‑82. (In Russ.) https://doi.org/10.17116/hirurgia2018677-82
  21. Tian D.H., Weller J., Hasmat S., Preventza O., Forrest P., Kiat H., Yan T.D. Temperature Selection in Antegrade Cerebral Perfusion for Aortic Arch Surgery: A Meta-Analysis. Ann Thorac Surg. 2019;108(1):283-291. PMID: 30682350. https://doi.org/10.1016/j.athoracsur.2018.12.029
  22. Anikina O.S., Soynov I.A., Kulyabin Yu.Yu., Amansakhatova E.N., Velyukhanov I.A., Arkhipov A.N., Ivanzov S.M., Manukian S.N., Kornilov I.A. Cerebral and end-organ protection outcomes following the Norwood procedure: A retrospective cohort study. Progress in Pediatric Cardiology. 2026;80(1):101893. https://doi.org/10.1016/j.ppedcard.2025.101893
  23. Бодров Д.А., Мишина М.О., Ким А.И., Казанцев К.Б., Свалов А.И., Тарасов Е.М. Селективная церебромиокардиальная нормотермическая перфузия при коррекции перерыва дуги аорты и коарктации аорты с тубулярной гипоплазией дуги у новорожденных. Детские болезни сердца и сосудов. 2021;4(18):281-287. https://doi.org/10.24022/1810-0686-2021-18-4-281-287 Bodrov D.A., Mishina M.O., Kim A.I., Kazantsev K.B., Svalov A.I., Tarasov E.M. Selective normothermic cerebromyocardial perfusion for interrupted aortic arch and coarctation of aorta with tubular arch hypoplasia correction in newborn. Children’s Heart and Vascular Diseases. 2021;18(4):281-287. (In Russ.) https://doi.org/10.24022/1810-0686-2021-18-4-281-287
  24. Hammel J.M. Supplemental Perfusion Techniques for Aortic Arch Reconstruction, With Emphasis on Direct Cannulation of the Descending Aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2019;22:14-20. PMID: 31027558. https://doi.org/10.1053/j.pcsu.2019.02.010
  25. Hammel J.M., Deptula J.J., Karamlou T., Wedemeyer E., Abdullah I., Duncan K.F. Newborn aortic arch reconstruction with descending aortic cannulation improves postoperative renal function. Ann Thorac Surg. 2013;96(5):1721-6. PMID: 23998412. https://doi.org/10.1016/j.athoracsur.2013.06.033
  26. Бойко А.М., Каменщиков Н.О., Мирошниченко А.Г., Подоксенов Ю.К., Свирко Ю.С., Луговский В.А., Дьякова М.Л., Кравченко И.В., Мухомедзянов А.В., Маслов Л.Н., Базарбекова Б.А., Петлин К.А., Панфилов Д.С., Козлов Б.Н. Оксид азота и митохондриальное повреждение в ткани почек при моделировании искусственного кровообращения и циркуляторного ареста: экспериментальное исследование. Патология кровообращения и кардиохирургия. 2024;28(1):41-49. https://doi.org/10.21688/1681-3472-2024-1-41-49 Boyko A.M., Kamenshchikov N.O., Miroshnichenko A.G., Podoksenov Yu.K., Svirko Yu.S., Lugovskiy V.A., Diakova M.L., Kravchenko I.V., Mukhomedzyanov A.V., Maslov L.N., Bazarbekova B.A., Petlin K.A., Panfilov D.S., Kozlov B.N. Nitric oxide and mitochondria injuries in kidney tissue upon a simulation of cardiopulmonary bypass and circulatory arrest: an experimental study. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2024;28(1):41-49. (In Russ.) https://doi.org/10.21688/1681-3472-2024-1-41-49
  27. Kreuzer M., Sames-Dolzer E., Schausberger L., Tulzer A., Ratschiller T., Haizinger B., Tulzer G., Mair R. Double-arterial cannulation: a strategy for whole body perfusion during aortic arch reconstruction. Interact Cardiovasc Thorac Surg. 2018;27(5):742-748. PMID: 29722889. https://doi.org/10.1093/icvts/ivy147
  28. Tan Recep B.Z., Tongut A., Hatemi A.C., Tuncer E., Yilmaz A.A., Ceyran H. Evaluation of postoperative renal functions and its effect on body perfusion in patients with double aortic cannulation. Cardiol Young. 2023;33(5):733-740. PMID: 35635193 https://doi.org/10.1017/S1047951122001627
  29. Fernández-Doblas J., Ortega-Loubon C., Pérez-Andreu J., Linés M., Fernández-Molina M., Abella R.F. Selective visceral perfusion improves renal flow and hepatic function in neonatal aortic arch repair. Interact Cardiovasc Thoracic Surg. 2018;27(3):395-401. PMID: 29590367. https://doi.org/10.1093/icvts/ivy091
  30. Сойнов И.А., Горбатых Ю.Н., Кулябин Ю.Ю., Берген Т.А., Рзаева К.А., Велюханов И.А., Ничай Н.Р., Архипов А.Н. Оценка перфузиологической органопротекции у новорожденных и младенцев после хирургической коррекции гипоплазии дуги аорты. Грудная и сердечно-сосудистая хирургия. 2023;65(3):294-305. https://doi.org/10.24022/0236-2791-2023-65-3-294-305 Soynov I.A., Gorbatikh Yu.N., Kulyabin Yu.Yu., Bergen T.A., Rzaeva K.A., Velyukhanov I.A., Nichay N.R., Arkhipov A.N. Evaluation of perfusion organ protection in newborns and infants after surgical correction of aortic arch hypoplasia. Russian Journal of Thoracic and Cardiovascular Surgery. 2023;65(3):294-305. (In Russ.) https://doi.org/10.24022/0236-2791-2023-65-3-294-305
  31. Kulyabin Y.Y., Gorbatykh Y.N., Soynov I.A., Zubritskiy A.V., Voitov A.V., Bogachev-Prokophiev A.V. Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants. World J Pediatr Congenit Heart Surg. 2020;11(1):49-55. PMID: 31835988. https://doi.org/10.1177/2150135119885887