The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants

Abstract Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion. Methods Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2). Results Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001). Conclusions SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.

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Near-Infrared Spectroscopy Assessment of Tissue Oxygenation During Selective Cerebral Perfusion for Neonatal Aortic Arch Reconstruction

Frontiers in Medicine ◽

10.3389/fmed.2021.637257 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chi-Hsiang Huang ◽

Yi-Chia Wang ◽

Hen-Wen Chou ◽

Shu-Chien Huang

Keyword(s):

Lower Extremity ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Near Infrared ◽

Tissue Oxygenation ◽

Mild Hypothermia ◽

Selective Cerebral Perfusion ◽

The Mean ◽

The Right ◽

Arch Reconstruction

Objective: Optimal selective cerebral perfusion (SCP) management for neonatal aortic arch surgery has not been extensively studied. We induced mild hypothermia during SCP and used the tissue oxygenation monitor to ensure adequate perfusion during the cardiopulmonary bypass (CPB).Methods: Eight cases were recruited from September 2018 to April 2020. SCP was maintained at 30°C, and CPB was adjusted to achieve a mean right radial artery pressure of 30 mmHg. The near-infrared tissue saturation (NIRS) monitor was applied to assess the right and left brain, flank, and lower extremity during the surgery.Results: During surgery, the mean age was 4.75 days, the mean body weight was 2.92 kg, the CPB duration was 86.5 ±18.7 min, the aortic cross-clamp time was 46.1 ± 12.7 min, and the SCP duration was 14.6±3.4 min. The brain NIRS before, during, and after SCP was 64.2, 67.2, and 71.5 on the left side and 67.9, 66.2, and 70.1 on the right side (p = NS), respectively. However, renal and lower extremity tissue oxygenation, respectively decreased from 61.6 and 62.4 before SCP to 37.7 and 39.9 after SCP (p < 0.05) and then increased to 70.1 and 90.4 after full body flow resumed. No stroke was reported postoperatively.Conclusion: SCP under mild hypothermia can aid in efficient maintenance of brain perfusion during neonatal arch reconstruction. The clinical outcome of this strategy was favorable for up to 20 min, but the safety duration of lower body ischemia warrants further analysis.

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ASSESSMENT OF THE IMMEDIATE RESULTS OF AORTIC COARCTATION SURGICAL CORRECTION UNDER CONDITIONS OF ANTEGRADE SELECTIVE CEREBRAL PERFUSION

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2019-98-5-188-195 ◽

2019 ◽

Vol 98 (5) ◽

pp. 188-195

Author(s):

E.V. Krivoschekov ◽

◽

O.A. Egunov ◽

A.Yu. Podoksenov ◽

N.M. Troshkinev ◽

...

Keyword(s):

Aortic Coarctation ◽

Cerebral Perfusion ◽

Surgical Correction ◽

Selective Cerebral Perfusion ◽

Antegrade Selective Cerebral Perfusion

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Regional High-Flow Cerebral Perfusion Improves Both Cerebral and Somatic Tissue Oxygenation in Aortic Arch Repair

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2010.03.113 ◽

2010 ◽

Vol 90 (2) ◽

pp. 593-599 ◽

Cited By ~ 14

Author(s):

Kagami Miyaji ◽

Takashi Miyamoto ◽

Satoshi Kohira ◽

Kei-ichi Itatani ◽

Takahiro Tomoyasu ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Tissue Oxygenation ◽

Somatic Tissue ◽

High Flow ◽

Aortic Arch Repair

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Association of Intraoperative Cerebral and Somatic Tissue Oxygen Saturation with Postoperative Cognitive Dysfunction After Spine Open Surgery in Patients with Hypertension: An Observational Study

10.21203/rs.3.rs-903012/v1 ◽

2021 ◽

Author(s):

Fei Guo ◽

Shuaiying Jia ◽

Qiyan Wang ◽

Qinyu Liu ◽

Mingquan Hu ◽

...

Keyword(s):

Observational Study ◽

Oxygen Saturation ◽

Cognitive Dysfunction ◽

Open Surgery ◽

Tissue Oxygenation ◽

Cerebral Oxygenation ◽

Postoperative Cognitive Dysfunction ◽

Somatic Tissue ◽

Tissue Oxygen Saturation ◽

Tissue Oxygen

Abstract Background: Intraoperative cerebral desaturations have been associated with worse neurological outcomes after supine surgery. However, it is not clear whether intraoperative somatic tissue oxygenation is more associated with postoperative cognitive dysfunction (POCD) than cerebral oxygenation in patients with hypertension after prone spine surgery.Methods: Patients with hypertension scheduled for spine open surgery were included from 2020 to 2021 in a single-center, prospective, observational study. Baseline both cerebral and somatic tissue oxygen saturation were measured in operating room before surgery. Cerebral and somatic tissue oxygen saturations were monitored continuously throughout surgery. The presence of POCD was assessed using the Mini-Mental Status Examination (MMSE). Association with POCD was evaluated with unadjusted analyses and multivariable logistic regression.Results: One hundred and one of 112 patients were included, and 28 (27.8%) developed POCD. None of the investigated SctO2 variables was predictive of POCD. On the contrary, the patients with POCD had a higher decrease in intraoperative absolute SstO2 decrease and relative SstO2 decrease compared with the patients without POCD (4.9%±3.8% vs. 3.6%±2.6%, P=0.037; 7.4%±5.6% vs. 5.3%±3.8%, P=0.036; respectively). Finally, three SstO2 parameters respectively were associated with POCD, including a higher absolute SstO2 decrease (OR, 1.223; 95%CI, 1.031-1.451; P=0.021), a higher absolute SstO2 decrease (OR, 1.138; 95%CI, 1.011-1.281; P=0.032) and falling below 90% of baseline SstO2 (OR, 11.388; 95%CI, 2.367-54.785; P=0.002), independent of ASA III, preoperative platelet and postoperative sepsis. Conclusions: Twenty-eight (27.8%) of 101patients developed POCD. Somatic tissue oxygenation has a stronger association with POCD than cerebral tissue oxygenation after spine open surgery in patients with hypertension.Clinical trial registration: ChiCTR1900028392. Registered 20 December 2019.

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