Search

Background: In an effort to optimize neurologic outcome, cerebral oxygen saturation (Sco 2) is often measured intraoperatively and postoperatively. We hypothesized that Sco 2 would be related to stage of palliation in children with single ventricle congenital heart disease. Methods: Cerebral oxygen saturation was continuously recorded intraoperatively in 34 infants and children undergoing palliative surgery on cardiopulmonary bypass for single ventricle congenital heart defects and in a control group of 12 neonates with ductus-dependent circulation undergoing complete repair. Saturations were correlated with the patient’s stage and outcome. Results: Baseline Sco 2 was 61% in single ventricle neonates (group P1, n = 10), 55% in neonates undergoing repair (group R), 42% in infants undergoing stage 2 palliation (group P2, n = 6), and 70% in children undergoing Fontan (group P3, n = 14). Baseline was lowest (41%) in infants undergoing interstage operations (group I, n = 4). After bypass, there was a significant improvement in Sco 2 to 53% in group P2 infants (p = 0.04); there were no significant changes in the other groups. By the end of the operation, there was a significant decrease in Sco 2 to 48% in group P1 (p = 0.001), with other groups unchanged from baseline. There were five perioperative deaths. Cerebral oxygen saturation at the conclusion of surgery was lower in children who died (38% versus 61%, p = 0.01). Conclusions: In children with single ventricle physiology, Sco 2 decreases after initial palliation, remains low before second-stage palliation, but is normal before and after the Fontan. This has implications for perioperative mortality, neurologic injury, and potentially for interim mortality. Low postoperative Sco 2 predicts perioperative mortality. [Copyright &y& Elsevier]

Abstract: Objectives: Despite recent significant improvement in outcome, children undergoing surgery for correction of congenital heart defects have a persistent and troublesome mortality rate and incidence of neurologic complications. Recent data suggest that some congenital heart defects are associated with abnormal brain development and with low cerebral blood flow. We hypothesized that some children with congenital heart disease have an abnormally low baseline (preoperative) cerebral oxygen saturation (ScO2). Methods: ScO2 was continuously recorded intraoperatively in 143 infants and children (age <18 years) undergoing repair of congenital heart defects on cardiopulmonary bypass. Baseline saturation was obtained prior to induction of anesthesia. Preoperative and postoperative saturations were correlated with the patient’s physiology (cyanotic vs. acyanotic, presence of ventricular- or arterial-level left-to-right shunts) and outcome. Results: Patient age ranged from 2 days to 17 years (median 8 months). Mean baseline ScO2 was 64%. Preoperative ScO2 was lower in infants with left to right shunt physiology (P < .01), but not in cyanotic infants without left-to-right shunts. Perioperative death was associated with baseline saturation less than 50%. Conclusions: Baseline ScO2 is lower in patients with left-to-right shunt physiology. Postoperative saturation is lower in patients with left-to-right shunt physiology and in cyanotic patients. Low baseline ScO2 predicts perioperative mortality in children with congenital heart disease. Measurement of ScO2 preoperatively will provide additional information for parent counseling, and preoperative optimization of ScO2 may improve outcome. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Cardiac Surgery Capacity in Sub-Saharan Africa: Quo Vadis?' by Charles Yankah and colleagues in the previous issue.