Heart surgery

Brain desaturation during neonatal congenital heart surgery is associated with perioperative alterations in brain structure but not neurodevelopmental outcomes at 1 year

This article was originally published here

Eur J Cardiothorac Surg. April 4, 2022: ezac138. doi: 10.1093/ejcts/ezac138. Online ahead of print.

ABSTRACT

OBJECTIVES: The importance of intraoperative cerebral desaturation (CD) measured by near-infrared spectroscopy (NIRS) in predicting neurological outcomes after congenital heart surgery is uncertain. The aim of this study was to compare brain structural changes and neurodevelopmental outcomes in patients with severe congenital heart disease with and without intraoperative CD.

METHODS: Newborns requiring congenital heart surgery were enrolled in a cohort study. NIRS data from their first heart operation has been collected. Pre- and postoperative cerebral magnetic resonance imaging results and Bayley-III scores at 1 year were compared between patients with and without CD, defined by 2 NIRS thresholds: regional cerebral oxygen saturation (rSO2) of 45% (45% rSO2) and rSO2 lower than 20% of the reference value (20% BLrSO2).

RESULTS: Thirty-two patients (72% male) with transposition of the great vessels (n=24.75%) and other complex types of congenital heart disease (n=8.25%) were analyzed. Perioperative lateral ventricular relative volume change increased in patients with or without intraoperative CD (P = 0.003 for 45% rSO2, P = 0.008 for 20% BLrSO2). For 45% rSO2, the effect of CD remained significant after adjusting for postoperative CT age, time between CT scans and cardiac diagnosis (P = 0.019). The new intracranial lesions occurred mainly in the CD groups (6/6 patients for 45% rSO2, 5/6 patients for 20% BLrSO2). Neurodevelopmental outcome at 1 year was not associated with intraoperative CD.

CONCLUSIONS: This study demonstrates the clinical relevance of NIRS monitoring during congenital heart surgery. The occurrence of intraoperative CD is associated with a change in the volume of the perioperative lateral ventricle and new intracranial lesions.

PMID:35373833 | DOI:10.1093/ejcts/ezac138