Deep hypothermic circulatory arrest and regional cerebral perfusion in pediatric cardiac surgery

The development of deep hypothermic circulatory arrest during the mid 1900s brought potential for cardiac operations not previously possible. However, as survival rates have improved for children with congenital heart disease, and longer term morbidities including neurodevelopment delays have been recognized, the role deep hypothermic circulatory arrest may play in causing neurologic insults, particularly for children requiring aortic arch reconstruction, has been of concern. Out of this concern, alternative techniques, including regional cerebral perfusion, have been developed.The purpose of this paper is to review the history of, and the data regarding neurodevelopmental outcomes, related to both deep hypothermic circulatory arrest and regional cerebral perfusion. Data from animal studies and clinical investigations will be reviewed. The reader will likely conclude that ultimately more information is required to determine the optimal perfusion strategy.