TY - JOUR
T1 - Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery
T2 - Effects of surgical duration
AU - Buckley, Erin M.
AU - Lynch, Jennifer M.
AU - Goff, Donna A.
AU - Schwab, Peter J.
AU - Baker, Wesley B.
AU - Durduran, Turgut
AU - Busch, David R.
AU - Nicolson, Susan C.
AU - Montenegro, Lisa M.
AU - Naim, Maryam Y.
AU - Xiao, Rui
AU - Spray, Thomas L.
AU - Yodh, A. G.
AU - Gaynor, J. William
AU - Licht, Daniel J.
PY - 2013/1
Y1 - 2013/1
N2 - Objective: The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO 2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods: Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results: Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P >.05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P >.05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions: Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further.
AB - Objective: The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO 2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods: Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results: Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P >.05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P >.05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions: Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further.
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U2 - 10.1016/j.jtcvs.2012.09.057
DO - 10.1016/j.jtcvs.2012.09.057
M3 - Article
C2 - 23111021
AN - SCOPUS:84871251060
SN - 0022-5223
VL - 145
SP - 196-205.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -