PERFUSE-1 Trial: Preliminary Results of a Prospective Randomized Comparison of Selective Upper Body vs. Combined Upper and Lower Body Perfusion for Aortic Arch Surgery in Pediatric Patients with Biventricular Circulations

All articles of this category (opens in new window) Background: Aortic arch repair (AAR) in infants with congenital heart disease requires complete interruption of aortic arch blood flow, necessitating protective strategies for cerebral, spinal, and visceral perfusion. Conventional deep hypothermic circulatory arrest has been largely replaced by antegrade cerebral perfusion (ACP), which ensures continuous cerebral blood flow but leaves the lower body unperfused, despite moderate hypothermia (25–32°C). Whether additional descending aortic cannulation (DAC) improves visceral protection remains unclear. Methods: In this prospective randomized trial, 40 infants (≤1 year) undergoing AAR are allocated to either adjunct DAC or standard ACP. Organ injury is assessed by conventional biomarkers (serum creatinine, CK, LDH) and novel markers (cystatin C, NGAL, I-FABP, IL-18). Intraoperative monitoring includes regional oxygen saturation (rSO 2 ) at the forehead, trunk, and thigh, as well as oxygen delivery ratio (DO 2 R). Safety endpoints comprise adverse events (AE), ventilation-free days within 30 postoperative days (VFD), postoperative ICU length of stay (PLOS), and 30-day mortality. Results: Interim analysis after enrollment of 25 patients: DAC significantly increased intraoperative oxygen delivery to the lower body and attenuated the decline in cerebral rSO 2 compared with ACP alone. However, no significant differences were observed in postoperative progression of conventional biomarkers, VFD, PLOS, or AE incidence. Median perfusion time during arch repair was 20 minutes (IQR: 16.5), aortic clamping time 46 minutes (IQR: 54.5), cardiopulmonary bypass time 87 minutes (IQR: 48.0), and total surgical duration 197 minutes (IQR: 86.5). Use of DAC did not prolong operative times. Conclusion: Adjunct DAC during infant AAR enhances intraoperative systemic and cerebral oxygenation without increasing procedural complexity. Preliminary findings do not demonstrate improvements in postoperative conventional biomarkers. Given that median perfusion times were within accepted thresholds of tolerable ischemia, potential long-term benefits of DAC may only emerge in settings of prolonged arch repair. Nevertheless, prior studies have demonstrated organ dysfunction even after brief periods of selective perfusion when assessed with organ-specific and highly sensitive biomarkers. Accordingly, we anticipate that the analysis of these parameters in the presented cohort will enable the detection of differences and potential effects between perfusion strategies. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany