Relationship of Intraoperative Cerebral Oxygen Saturation to Neurodevelopmental Outcome and Brain Magnetic Resonance Imaging at 1 Year of Age in Infants Undergoing Biventricular Repair

被引：147

作者：

Kussman, Barry D. ^{[1
,6
]}

Wypij, David ^{[2
,7
,10
]}

Laussen, Peter C. ^{[1
,2
,6
]}

Soul, Janet S. ^{[3
]}

Bellinger, David C. ^{[3
]}

DiNardo, James A. ^{[1
,6
]}

Robertson, Richard ^{[4
,8
]}

Pigula, Frank A. ^{[5
,9
]}

Jonas, Richard A. ^{[5
,9
]}

Newburger, Jane W. ^{[2
,7
]}

机构：

[1] Childrens Hosp, Dept Anesthesiol Perioperat & Pain Med, Boston, MA 02115 USA

[2] Childrens Hosp, Dept Cardiol, Boston, MA 02115 USA

[3] Childrens Hosp, Dept Neurol, Boston, MA 02115 USA

[4] Childrens Hosp, Dept Radiol, Boston, MA 02115 USA

[5] Childrens Hosp, Dept Cardiovasc Surg, Boston, MA 02115 USA

[6] Harvard Univ, Sch Med, Dept Anaesthesia, Boston, MA 02115 USA

[7] Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA

[8] Harvard Univ, Sch Med, Dept Radiol, Boston, MA 02115 USA

[9] Harvard Univ, Sch Med, Dept Surg, Boston, MA 02115 USA

[10] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA

来源：

CIRCULATION | 2010年 / 122卷 / 03期

基金：

美国国家卫生研究院;

关键词：

heart defects; congenital; brain; oxygen; spectroscopy; near-infrared; magnetic resonance imaging; HYPOTHERMIC CARDIOPULMONARY BYPASS; CIRCULATORY ARREST; NORWOOD PROCEDURE; BLOOD-FLOW; PERFUSION; INJURY; HEMODYNAMICS; PREDICTION; CHILDREN; TRIAL;

D O I：

10.1161/CIRCULATIONAHA.109.902338

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Near-infrared spectroscopy monitoring of cerebral oxygen saturation (rSO(2)) has become routine in many centers, but no studies have reported the relationship of intraoperative near-infrared spectroscopy to long-term neurodevelopmental outcomes after cardiac surgery. Methods and Results-Of 104 infants undergoing biventricular repair without aortic arch reconstruction, 89 (86%) returned for neurodevelopmental testing at 1 year of age. The primary near-infrared spectroscopy variable was the integrated rSO(2) (area under the curve) for rSO(2) <= 45%; secondary variables were the average and minimum rSO(2) by perfusion phase and at specific time points. Psychomotor and mental development indexes of the Bayley scales, head circumference, neurological examination, and abnormalities on brain magnetic resonance imaging did not differ between subjects according to a threshold level for rSO(2) of 45%. Lower Psychomotor Development Index scores were modestly associated with lower average (r=0.23, P=0.03) and minimum (r=0.22, P=0.04) rSO(2) during the 60-minute period after cardiopulmonary bypass but not with other perfusion phases. Hemosiderin foci on brain magnetic resonance imaging were associated with lower average rSO(2) from postinduction to 60 minutes post cardiopulmonary bypass (71 +/- 10% versus 78 +/- 6%, P=0.01) and with lower average rSO(2) during the rewarming phase (72 +/- 12% versus 83 +/- 9%, P=.003) and during the 60-minute period following cardiopulmonary bypass (65 +/- 11% versus 75 +/- 10%, P=0.009). In regression analyses that adjusted for age <= 30 days, Psychomotor Development Index score (P=0.02) and brain hemosiderin (P=0.04) remained significantly associated with rSO(2) during the 60-minute period following cardiopulmonary bypass. Conclusions-Perioperative periods of diminished cerebral oxygen delivery, as indicated by rSO(2), are associated with 1-year Psychomotor Development Index and brain magnetic resonance imaging abnormalities among infants undergoing reparative heart surgery.

引用

页码：245 / 254

页数：10

共 45 条

[1] Regional low-flow perfusion provides comparable blood flow and oxygenation to both cerebral hemispheres during neonatal aortic arch reconstruction [J].