Cerebral desaturation during neonatal congenital heart surgery is associated with perioperative brain structure alterations but not with neurodevelopmental outcome at 1 year

Abstract

OBJECTIVES The significance of intraoperative cerebral desaturation (CD) measured by near-infrared spectroscopy (NIRS) to predict neurological outcome after congenital heart surgery is uncertain. The goal of this study was to compare brain structure changes and neurodevelopmental outcome in patients with severe congenital heart disease with and without intraoperative CD. METHODS Neonates requiring congenital heart surgery were enrolled in a cohort study. NIRS data from their first cardiac operation were collected. Pre- and postoperative brain 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 below 20% of baseline value (20%BLrSO2). RESULTS Thirty-two patients (72% male) with d-transposition of the great arteries (n = 24, 75%) and other complex types of congenital heart diseases (n = 8, 25%) were analysed. Perioperative relative lateral ventricle volume change was increased in patients with versus 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 age at postoperative scan, time between scans and cardiac diagnosis (P = 0.019). New intracranial lesions occurred predominantly in 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 perioperative lateral ventricle volume change and new intracranial lesions.

The Year in Review: Anesthesia for Congenital Heart Disease 2022

“…Patients with intraoperative CD had a higher incidence of new postoperative intracranial lesions as well as increased lateral ventricle volume on brain MRI. 46 However, no differences in total brain volume were noted between cohorts suggesting CD did not result in significant parenchymal loss. 46 Additionally, no significant differences in neurodevelopmental outcomes at 1 year of age were detected highlighting the need for further investigation into the impact of cerebral desaturation on neurodevelopmental outcomes beyond 1 year.…”

Cerebral near-infrared spectroscopy monitoring to predict periventricular-intraventricular haemorrhage and neurodevelopmental outcomes in preterm infants: a protocol for a systematic review and meta-analysis

“…It has been widely used for the prediction of possible neurological dysfunction, surgery monitoring and pain assessment in newborn infants. [15][16][17][18][19][20] NIRS is used to monitor the oxygen saturation of local tissue by using the different absorption rates of oxygen, haemoglobin and deoxyhaemoglobin. The oxygen consumption of local tissue can be calculated in combination with the whole-body oxygen saturation in the same period.…”