Cerebral regional oxygenation during aortic coarctation repair in pediatric population

• Published in: European journal of cardio-thoracic surgery 2008-07, Vol.34 (1), p.26-31
• Main Authors: Farouk, Ahmed, Karimi, Mohsen, Henderson, Mark, Ostrowsky, Jacob, Siwik, Ernest, Hennein, Hani
• Format: Article
• Language: English
• Subjects: Aortic coarctation; Aortic Coarctation - physiopathology; Aortic Coarctation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Artery, Common - physiopathology; Cerebral protection; Cerebrovascular Circulation; Child; Child, Preschool; Constriction; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Infant; Infant, Newborn; Intraoperative Care - methods; Male; Medical sciences; Monitoring, Intraoperative - methods; Near-infrared spectroscopy; Oxygen - blood; Pneumology; Retrospective Studies; Spectroscopy, Near-Infrared - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.03.042

Objective: During repair of aortic coarctation, clamping of the transverse aortic arch proximal to the left common carotid artery occludes blood flow to the left carotid and vertebral arteries. The objective of the present study is to determine whether blood flow through the right carotid and vertebral arteries provides adequate cerebral blood flow during aortic cross-clamping, as assessed by near-infrared spectroscopy. Methods: In 11 consecutive children undergoing aortic coarctation repair through a standard posterolateral thoracotomy, regional cerebral oxygen saturation (cSO2) was measured using near-infrared spectroscopy. Six patients underwent an extended end-to-end repair, in which the aortic cross-clamp was placed in between the innominate and left common carotid arteries (extended repair group). Five patients underwent a standard end-to-end repair in which the cross-clamp was clamp placed between the left common carotid and subclavian arteries (standard repair group). Results: After aortic clamping, there was a significant decrease in cSO2 in the extended repair group, whereas the cSO2 increased in the standard repair group (−9.2 ± 12.2 vs 6.0 ± 5.1%, extended vs standard repair groups, p = 0.03). In the extended repair group, the cSO2 decreased linearly during the aortic cross-clamping period (rS = −0.842, p