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Eur J Cardiothorac Surg 1998;14:415-418
© 1998 Elsevier Science NL

Monitoring of regional cerebral oxygenation by near-infrared spectroscopy during continuous retrograde cerebral perfusion for aortic arch surgery¹

Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632 Japan

Received 29 December 1997; received in revised form 25 May 1998; accepted 27 May 1998.

Corresponding author. Tel.: +81 743 635611; fax: +81 743 625576.

Objective: To assess the value of monitoring of regional cerebral oxygen saturation (rSO₂) during aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) in conjunction with profound hypothermic circulatory arrest (HCA). Methods: The rSO₂ of 12 consecutive patients was monitored non-invasively using near-infrared spectroscopy (NIRS) and the data were analyzed statistically. Results: The mean duration of HCA with CRCP was 62±14.1 min. The mean CRCP flow rate was 226±163 ml/min. Surgical outcomes were favorable with only a single hospital death (8.3%). However, the rSO₂ decreased gradually in all patients during HCA, even combined with CRCP, and fell to 46±8.7% on average. It did not change so greatly before HCA and returned finally to its initial level at the end of re-warming. Only one patient developed a permanent neurologic deficit; this patient showed the greatest decrease of rSO₂ from 56% to 29% after the longest HCA of 88 min. Two parameters, End-rSO₂ (the ratio of post- to pre-HCA rSO₂) and -rSO₂ (the rate of decrease from pre- to post-HCA rSO₂) were obtained since the initial values of rSO₂ before surgery differed. There were linear correlations between the CRCP flow rate and each of these two parameters. A multiple regression analysis also revealed a linear equation relating the parameters, which allowed prediction of the safe duration of HCA in different conditions of CRCP and a more favorable adjustment of the CRCP condition in each patient. Conclusions: The study suggests that the combination of HCA and CRCP has a limit of safe duration in spite of its potential usefulness for brain protection, and that rSO₂ monitored by NIRS is useful in testing for adequate brain protection. It is hoped that monitoring of rSO₂ can facilitate prediction of the safe duration of HCA with CRCP and a more favorable adjustment of CRCP.

Key Words: Regional cerebral oxygen saturation • Near-infrared spectroscopy • Profound hypothermic circulatory arrest • Continuous retrograde cerebral perfusion • Aortic arch surgery

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