HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sally Cai Christopher A. Caldarone Andrew N. Redington Glen S. Van Arsdell Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Li, J. Articles by Van Arsdell, G. S. Search for Related Content PubMed Articles by Li, J. Articles by Van Arsdell, G. S. Related Collections Cardiac - other Cerebral protection

J Thorac Cardiovasc Surg 2008;135:83-90
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure

^a Heart Center, the Hospital for Sick Children, Toronto, Ontario, Canada
^b Data Center, Congenital Heart Surgeon’s Society, Toronto, Ontario, Canada.

Received for publication April 27, 2007; revisions received June 8, 2007; accepted for publication July 9, 2007.

^_* Address for reprints: Jia Li, MD, PhD, Division of Cardiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. (Email: jia.li{at}sickkids.ca).

Objectives: Ischemic brain injury is an important morbidity in neonates after the Norwood procedure. Its relationship to systemic hemodynamic oxygen transport is poorly understood.

Methods: Sixteen neonates undergoing the Norwood procedure were studied. Continuous cerebral oxygen saturation was measured by near-infrared spectroscopy. Continuous oxygen consumption was measured by respiratory mass spectrometry. Pulmonary and systemic blood flow, systemic vascular resistance, oxygen delivery, and oxygen extraction ratio were derived with measurements of arterial, and superior vena cava and pulmonary venous gases and pressures at 2- to 4-hour intervals during the first 72 hours in the intensive care unit.

Results: Mean cerebral oxygen saturation was 66% ± 12% before the operation, reduced to 51% ± 13% on arrival in the intensive care unit, and remained low during the first 8 hours; it increased to 56% ± 9% at 72 hours, still significantly lower than the preoperative level (P < .05). Postoperatively, cerebral oxygen saturation was closely and positively correlated with systemic arterial pressure, arterial oxygen saturation, and arterial oxygen tension and negatively with oxygen extraction ratio (P < .0001 for all). Cerebral oxygen saturation was moderately and positively correlated with systemic blood flow and oxygen delivery (P < .0001 for both). It was weakly and positively correlated with pulmonary blood flow (P = .001) and hemoglobin (P = .02) and negatively correlated with systemic vascular resistance (P = .003). It was not correlated with oxygen consumption (P > .05).

Conclusions: Cerebral oxygen saturation decreased significantly in neonates during the early postoperative period after the Norwood procedure and was significantly influenced by systemic hemodynamic and metabolic events. As such, hemodynamic interventions to modify systemic oxygen transport may provide further opportunities to reduce the risk of cerebral ischemia and improve neurodevelopmental outcomes.