Cerebral oximetry during infant cardiac surgery: evaluation and relationship to early postoperative outcome.
BACKGROUND
We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome.


METHODS
Regional cerebral oxygen saturation (rSO(2)) was measured by near-infrared spectroscopy in 104 infants undergoing biventricular repair without aortic arch obstruction as part of a randomized trial of hemodilution to a hematocrit of 25% vs 35%.


RESULTS
Before cardiopulmonary bypass (CPB), infants with tetralogy of Fallot had higher rSO(2) values compared to those with D-transposition of the great arteries (D-TGA) or ventricular septal defect (P < 0.001). During CPB cooling, low flow, and at the termination of CPB, D-TGA subjects had the highest rSO(2) values (P < 0.001). There were no significant associations between intraoperative rSO(2) and early postoperative outcomes after adjustment for diagnosis. In 39 D-TGA subjects with > or =5 min of deep hypothermic circulatory arrest (DHCA), there was no correlation between the rSO(2) (91% +/- 6%) or hematocrit (29.2% +/- 5.5%) at the onset of arrest and the rate of decline in rSO(2) during arrest.


CONCLUSIONS
Intraoperative rSO(2) varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of DHCA.
Kussman
Barry D
BD
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. barry.kussman@childrens.harvard.edu
Wypij
David
D
DiNardo
James A
JA
Newburger
Jane W
JW
Mayer
John E
JE
del Nido
Pedro J
PJ
Bacha
Emile A
EA
Pigula
Frank
F
McGrath
Ellen
E
Laussen
Peter C
PC
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002493:Central Nervous System Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006400:Hematocrit; D006438:Hemodilution; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D016896:Treatment Outcome
D010100:Oxygen