Abstract

BackgroundSuboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion.Methods Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2).ResultsData of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001).Conclusions SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.

Highlights

  • Coarctation of the aorta (CoA) is a congenital narrowing of upper descending thoracic aorta adjacent to the site of attachment of ductus arteriosus just distal to the left subclavian artery

  • Our study showed that the measurements of ­Cerebral and tissue oxygen saturation (SctO2) and ­Somatic and tissue oxygen saturation (SstO2) is surgical stage-dependent in neonates and infants undergoing aortic coarctation repair

  • S­ stO2 was significantly lower than ­SctO2 before aortic opening; following aortic opening, ­SstO2 was significantly higher than SctO2. ­SctO2 and ­SstO2 have distinct correlations with mean arterial pressure (MAP), P­ aCO2, hematocrit, and temperature. ­SstO2 consistently correlates with leg MAP; the correlation between S­ ctO2 and arm MAP is confounded by the measurements during selective cerebral perfusion (SCP)

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Summary

Introduction

Coarctation of the aorta (CoA) is a congenital narrowing of upper descending thoracic aorta adjacent to the site of attachment of ductus arteriosus just distal to the left subclavian artery. The reported prevalence of CoA is approximately 4 per 10,000 live births [1, 2] or 400 per million live births, [3] which accounts for ~4 % of all congenital heart defects [3]. The optimal age for elective repair of aortic coarctation is controversial. Some centers perform elective aortic coarctation repair around 1.5 years of age [6]. Surgery at a much earlier age may be required depending on the severity of the coarctation and the adequacy of the collateral flow. Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion

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