Abstract
Objectives:
This study aims to compare the immediate postoperative clinical and laboratory outcomes, specifically focusing on the extent of cardiomyocyte death, between hypothermic (28°C) and normothermic (34–36°C) cardiopulmonary bypass in neonates undergoing arterial switch operation.
Methods:
A retrospective analysis was conducted on neonates who underwent arterial switch operation at the Edmond and Lily Safra Children's Hospital between July 2017 and December 2018. Patients were divided into two groups based on the cardiopulmonary bypass temperature strategy. Clinical, demographic, biochemical, and surgical data were collected, including cell-free DNA concentrations at multiple time points. Statistical analyses were performed to compare the outcomes between the two groups.
Results:
The study included 27 patients, with 12 in the hypothermia group and 15 in the normothermia group. Significant differences were found in cardiopulmonary bypass and aortic cross-clamp times, with longer durations in the nypothermia group (p < 0.001). Postoperative maximal lactate and Troponin-I levels were higher in the hypothermia group (p = 0.028 and p < 0.001, respectively). The normothermia group showed a higher incidence of acute kidney injury (p = 0.004). No significant differences were observed in total cell-free DNA levels between the groups, except for higher cardiac cell-free DNA at 24 hours in the hypothermia group (p = 0.002).
Conclusions:
Normothermia during cardiopulmonary bypass is associated with shorter operative times, lower metabolic stress, and reduced myocardial injury compared to hypothermia. Despite a higher incidence of acute kidney injury, normothermia demonstrates comparable safety and may offer benefits in myocardial preservation during neonatal arterial switch operation.