Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery

Fischer, Gregory W.; Lin, Hung-Mo; Krol, Marina; Galati, Maria F.; Di Luozzo, Gabriele; Griepp, Randall B.; Reich, David L.

doi:10.1016/j.jtcvs.2010.05.017

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 3 , Pages 815-821, March 2011

Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery

Gregory W. Fischer, MD
- Department of Anesthesiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
- Address for reprints: Gregory W. Fischer, MD, Department of Anesthesiology & Cardiothoracic Surgery, One Gustave L. Levy Place, Box 1010, Mount Sinai Medical Center, New York, NY 10029.
Hung-Mo Lin, PhD
- Department of Anesthesiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
Marina Krol, PhD
- Department of Anesthesiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
Maria F. Galati, MBA
- Department of Anesthesiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
Gabriele Di Luozzo, MD
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
Randall B. Griepp, MD
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY
David L. Reich, MD
- Department of Anesthesiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY

Received 1 December 2009; received in revised form 5 May 2010; accepted 16 May 2010. published online 25 June 2010.

Objectives

Surgical repair of the aortic arch remains technically challenging and is associated with considerable morbidity and mortality. Cerebral oximetry is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. We hypothesized that magnitude and duration of decreased intraoperative regional oxygen saturation was associated with postoperative organ dysfunction. Additionally, we sought to identify regional oxygen saturation threshold values that are predictive of organ dysfunction.

Methods

The intraoperative regional oxygen saturation values of 30 patients undergoing aortic arch surgery were recorded and analyzed. Postoperative complications were categorized as “major” and “minor.” Severe adverse outcome, extubation time, intensive care unit length of stay, and hospital length of stay data were collected and compared with the integrals of regional oxygen saturation and time (area under the threshold) spent beneath predetermined absolute threshold limits.

Results

Twenty subjects underwent hemiarch replacement, and 10 subjects received total aortic arch replacements. There were 30 major and 29 minor complications identified. Sixteen (53.3%) patients had at least 1 major complication. Logistic regression showed statistically significant associations between area under the threshold and severe adverse outcome incidence for regional oxygen saturation thresholds of 60% (P = .038) and 65% (P = .025). Patients who spent more than 30 minutes under the absolute threshold of 60% had an extended hospital stay of 4 days leading to an additional cost of $8300.00.

Conclusions

Our findings lend evidence to support the association of decreased perioperative cerebral oxygenation values with poor outcomes after aortic arch surgery.

CTSNet classification: 1, 19, 26

Abbreviations and Acronyms: AUT, area under the threshold, CPB, cardiopulmonary bypass, DHCA, deep hypothermic circulatory arrest, ICU, intensive care unit, LOS, length of stay, SAO, severe adverse outcome, SCP, selective cerebral perfusion, Scto₂, cerebral tissue oxygen saturation, TUT, time under the threshold