Cerebral Oximetry Monitoring in Patients Undergoing Surgery for Stanford Type A Aortic Dissection

Abstract

The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO2) in patients undergoing surgery for Stanford type A aortic dissection (TAAD). Observational, retrospective, institutional study. University hospital. A total of 152 patients who underwent surgery for TAAD from June 2009 to December 2018 at the authors' institution. Surgery for TAAD using continuous perioperative monitoring of crSO2 with near-infrared cerebral oximetry (INVOS, Medtronic, MN). The rates of postoperative stroke/global brain ischemia were 22.4% and of hospital mortality 14.5%. Age, hemoglobin, and cardiogenic shock were independent predictors of nadir crSO2 from both frontal areas at arrival to the operating room. Repeated measures test showed that changes in crSO2 between the first measurement at operating room arrival, at the start of surgery, and at the end of surgery were not significant when measured on the right frontal area (p = 0.632), left frontal area (p = 0.608), as a nadir value from both frontal areas (p = 0.690), and as a difference between frontal areas (p = 0.826) in patients with and without major neurologic complications. Patients who had a nadir crSO2 <40% anytime during the perioperative period, had a numerically higher rate of major neurologic complications (27.3% v 20.4%, p = 0.354), but this difference did not reach statistical significance. The incidence of nadir of crSO2 value <40% at operating room arrival (5.9%, p = 1.000), at the start of surgery (5.3%, p = 0.685), and at the end of surgery (1.3%, p = 1.000) was rather low and not associated with these adverse events. Derangements in crSO2 detected by cerebral oximetry before and during surgery for TAAD did not predict postoperative stroke and/or global brain ischemia.