Abstract
BackgroundAortic arch repair for aortic dissection is still associated with a high mortality rate. Providing adequate means of neuromonitoring to guide cerebral hemodynamics is advantageous, especially during selective anterior cerebral perfusion (SACP).ObjectiveWe aimed to investigate an easy multimodal neuromonitoring set-up consisting of processed electroencephalography (EEG), near infrared spectroscopy (NIRS), and transcranial doppler sonography (TCD).Material and methodsWe collected intraoperative data from six patients undergoing surgery for aortic dissection. In addition to standard hemodynamic monitoring, patients underwent continuous bilateral NIRS, processed EEG with bispectral index (BIS), and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B‑mode ultrasound device. Doppler measurements were taken bilaterally before cardiopulmonary bypass (CPB), during CPB, and during SACP at regular intervals.ResultsOf the patients four survived without neurological deficits while two suffered fatal outcomes. Of the survivors two suffered from transient postoperative delirium. Multimodal monitoring led to a change in CPB flow or cannula repositioning in three patients. Left-sided mean flow velocities of the MCA decreased during SACP, as did BIS values.ConclusionMonitoring consisting of BIS, NIRS, and TCD may have an impact on hemodynamic management in aortic arch operations.Supplementary InformationThe online version of this paper (10.1007/s00101-021-00983-y) contains a supplementary table showing all intraoperative measurements, which is available to authorized users.Article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field, the additional material can be found at the article under “Ergänzende Inhalte”.
Highlights
Introduction and backgroundAortic arch repair is one of the most invasive procedures currently performed
While near infrared spectroscopy (NIRS) has become the standard of care in aortic arch repair the transcranial doppler sonography (TCD) is rarely utilized
The TCD showed a right-sided increase in MCA velocity (MCAV) of 3 cm/s (16%) while leftsided MCAV decreased by 5 cm/s (23%), Table 2 Intraoperative bispectral index (BIS), NIRS, and MCAV values of all patients
Summary
Aortic arch repair is one of the most invasive procedures currently performed. It requires phases of circulatory arrest and selective anterior cerebral perfusion (SACP) via the carotid arteries [1]. In SACP, few neuromonitoring options remain, such as near infrared spectroscopy (NIRS) and transcranial doppler sonography (TCD). We aimed to investigate an easy multimodal neuromonitoring set-up consisting of processed electroencephalography (EEG), near infrared spectroscopy (NIRS), and transcranial doppler sonography (TCD). In addition to standard hemodynamic monitoring, patients underwent continuous bilateral NIRS, processed EEG with bispectral index (BIS), and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B-mode ultrasound device. Monitoring consisting of BIS, NIRS, and TCD may have an impact on hemodynamic management in aortic arch operations
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