Cerebral oxygenation monitoring for total arch replacement using selective cerebral perfusion.
BACKGROUND
This study was undertaken to verify the safety of our total arch replacement assisted by selective cerebral perfusion with respect to cerebral oxygenation.


METHODS
Subjects to be evaluated were selected between February 1999 and March 2000 and comprised 13 patients who underwent total arch replacement (TAR) (TAR group) and 18 patients who had undergone coronary artery bypass grafting or valve replacement (control group). They were monitored throughout the operation by two-channel near-infrared spectroscopy. Changes in intracranial oxyhemoglobin and the tissue oxygenation index were compared between the two groups. Additionally, jugular venous oxygen saturation was simultaneously measured in 10 patients from each group. Maximum changes in these variables from baseline in the TAR group were compared with those in the control group. Bilateral oxygenation differences between two hemispheres were also evaluated.


RESULTS
There was no incidence of postoperative cerebral infarction, and no significant difference was observed in the maximum decrease in these variables between the two groups. Bilateral oxygenation differences between the two hemispheres in the TAR group were similar to those in the control group, except for the tissue oxygenation index in the rewarming phase.


CONCLUSIONS
From the standpoint of cerebral oxygenation, our technique of total arch replacement was nearly as safe as an ordinary cardiac operation.
Yamashita
K
K
First Department of Surgery, Hamamatsu University School of Medicine, Japan. surglass@akiha.hama-med.ac.jp
Kazui
T
T
Terada
H
H
Washiyama
N
N
Suzuki
K
K
Bashar
A H
AH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001921:Brain / Q000098:blood supply*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D010101:Oxygen Consumption / Q000502:physiology*; D010108:Oxyhemoglobins / Q000378:metabolism; D012039:Regional Blood Flow / Q000502:physiology; D019265:Spectroscopy, Near-Infrared
D010108:Oxyhemoglobins