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7. Regional cerebral tissue saturation is useful in predicting stroke after operations involving the aortic arch with selective antegrade cerebral perfusion
Christian Olsson, Stefan Thelin; Uppsala, Sweden
Regional cerebral tissue saturation is useful in predicting stroke after operations involving the aortic arch with selective antegrade cerebral perfusion
Objective
To test the hypothesis that regional cerebral tissue oxygen saturation (rSO2) monitoring during hypothermic selective antegrade cerebral perfusion (SACP) in surgery involving the aortic arch can predict neurological sequelae.
Methods
In 46 consecutive patients data were collected prospectively. SACP was established by perfusion of the right subclavian artery (± left carotid artery perfusion) or by separate concomitant perfusion of the innominate and the left carotid arteries. Bilateral rSO2 data were collected at pre-specified time-points during surgery using near-infrared spectroscopy (NIRS) equipment (INVOS 4100). Stroke was the primary endpoint. NIRS data were analyzed to determine diagnostic accuracy in detecting intraoperative cerebral desaturation related to stroke.
Results
Of the patients, 31 (67%) were men, age range was 5 - 78 years (median, 61) and 25 (54%) had acute aortic dissection. Six patients (13%) suffered a perioperative stroke. In-hospital mortality was 13%. SACP ranged from 8 to 105 min (median, 32 min). There were no statistically significant differences in left and right rSO2 values between patients with unilateral or bilateral SACP. Values of rSO2 showed minimal relationship to simultaneous pH, pCO2, pO2, MAP or EVF, or to flow and temperature during SACP. Generally, rSO2 decreased at the onset of SACP, was completely or partially restituted during SACP, and increased during rewarming and after discontinuation of CPB. After establishing CPB, rSO2 values relative to baseline were significantly lower during SACP in patients with stroke (figure; error bars, SEM). In ROC curve analysis, the AUC for relative rSO2 values during SACP ranged from 0.75 to 0.87. During SACP, rSO2 between 76 and 87% of baseline had a sensitivity of 80 - 83% and a specificity of 58 - 85% in identifying individuals with stroke.
Conclusions
Monitoring of rSO2 using NIRS during SACP allows detection of clinically important cerebral desaturation. It can help predict perioperative neurological sequelae. It is useful as a non-invasive trend monitor and provides unique information that is not inferred from standard intraoperative monitoring. 
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