Intraoperative cerebral oximetry in open heart surgeries reduced postoperative complications: A retrospective study

Abstract

Cardiothoracic surgeries are life-saving procedures but often it results in various complications. Intraoperative cerebral oximetry monitoring used to detect regional cerebral oxygen saturation (rScO2) is a non-invasive method that provides prognostic importance in cardiac surgery. The main aim of the present study was to evaluate the association of intraoperative cerebral oxygen monitoring during cardiac surgery on postoperative complications. This was a case-controlled retrospective study conducted on adult patients, who underwent open-heart surgery in National Heart Institute, Malaysia. The case group comprised patients on protocolized cerebral oximetry monitoring. They were treated using a standardized algorithm to maintain rScO2 not lower than 20% of baseline rScO2. The control group comprised patients with matched demographic background, preoperative risk factors, and type of surgical procedures. Propensity score stratification was utilized to contend with selection bias. Retrospective analysis was performed on 240 patients (case group) while comparing it to 407 patients (control group). The non-availability of cerebral oximetry monitoring during surgery was the prominent predictor for all outcome of complications; stroke (OR: 7.66), renal failure needing dialysis (OR: 5.12) and mortality (OR: 20.51). Postoperative complications revealed that there were significant differences for risk of mortality (p<0.001, OR = 20.51), renal failure that required dialysis (p<0.001, OR = 5.12) and stroke (p <0.05, OR = 7.66). Protocolized cerebral oximetry monitoring during cardiothoracic surgeries was found to be associated with lower incidence of stroke, renal failure requiring dialysis and mortality rate.

Microarray Profiling of Differentially Expressed Genes in Coronary Artery Bypass Grafts of High-Risk Patients with Postoperative Cognitive Dysfunctions

“…A study proves that preserving blood flow to the brain has lesser adverse outcomes post-open-heart surgery [25]. Maintaining cerebral blood perfusion will ensure a stable blood flow to the brain.…”

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction

“…Another single-center prospective trial examining NIRS-directed intraoperative interventions (including fluid challenge, deepening anesthesia, and administration of vasoactive medications) during episodes of cerebral oxygen desaturation (< 60% for > 60 consecutive seconds) during CPB found that 6 months postoperative group mean memory change scores were significantly improved in the intervention group, although overall perioperative outcomes did not differ between intervention and control groups ( 181 ). Likewise, a retrospective study evaluating association of intraoperative cerebral oxygen monitoring during cardiopulmonary bypass on postoperative complications found that cerebral oximetry monitoring during cardiothoracic surgery was associated with lower incidence of stroke and overall mortality rate ( 182 ).…”

Cerebral Oximetry-Monitored Nitroglycerin Infusion and Tissue Perfusion during Rewarming of Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial

“…Therefore, real-time autoregulation monitoring using near-infrared spectroscopy may provide a more rational basis for individualizing blood pressure to measure injurious hypotension (mean < 45 mmHg) [18] and perioperative stroke [16] during CPB. Precise diagnostic tools can be leveraged to deliver personalized treatments and provide prognostic improvements regarding postoperative morbidity and mortality in cardiac surgery [10,11]. A relative 20% reduction of the baseline value or an absolute value lower than 50% is a suggested threshold for intervention [19][20][21].…”

“…The duration and magnitude of blood pressure below the autoregulation threshold were independently associated with major morbidity or operative mortality after cardiac surgery [10]. Therefore, regional cerebral oximetry monitoring has been recommended during cardiothoracic surgery [11] and applied to guide nitroglycerin infusion during controlled hypotension for major open urological or abdominal surgery [12].…”