Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery: Effects of surgical duration

Erin M. Buckley, Jennifer M. Lynch, Donna A. Goff, Peter J. Schwab, Wesley B. Baker, Turgut Durduran, David R. Busch, Susan C. Nicolson, Lisa M. Montenegro, Maryam Y. Naim, Rui Xiao, Thomas L. Spray, A. G. Yodh, J. William Gaynor, Daniel J. Licht

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective: The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO 2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods: Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results: Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P >.05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P >.05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions: Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further.

Original languageEnglish (US)
Pages (from-to)196-205.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

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Cerebrovascular Circulation
Thoracic Surgery
Oxygen
Deep Hypothermia Induced Circulatory Arrest
Spectrum Analysis
Postoperative Period
Brain Injuries
Observational Studies
Technology

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery : Effects of surgical duration. / Buckley, Erin M.; Lynch, Jennifer M.; Goff, Donna A.; Schwab, Peter J.; Baker, Wesley B.; Durduran, Turgut; Busch, David R.; Nicolson, Susan C.; Montenegro, Lisa M.; Naim, Maryam Y.; Xiao, Rui; Spray, Thomas L.; Yodh, A. G.; Gaynor, J. William; Licht, Daniel J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 1, 01.2013, p. 196-205.e1.

Research output: Contribution to journalArticle

Buckley, EM, Lynch, JM, Goff, DA, Schwab, PJ, Baker, WB, Durduran, T, Busch, DR, Nicolson, SC, Montenegro, LM, Naim, MY, Xiao, R, Spray, TL, Yodh, AG, Gaynor, JW & Licht, DJ 2013, 'Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery: Effects of surgical duration', Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 1, pp. 196-205.e1. https://doi.org/10.1016/j.jtcvs.2012.09.057
Buckley, Erin M. ; Lynch, Jennifer M. ; Goff, Donna A. ; Schwab, Peter J. ; Baker, Wesley B. ; Durduran, Turgut ; Busch, David R. ; Nicolson, Susan C. ; Montenegro, Lisa M. ; Naim, Maryam Y. ; Xiao, Rui ; Spray, Thomas L. ; Yodh, A. G. ; Gaynor, J. William ; Licht, Daniel J. / Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery : Effects of surgical duration. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 1. pp. 196-205.e1.
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AU - Lynch, Jennifer M.

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AU - Schwab, Peter J.

AU - Baker, Wesley B.

AU - Durduran, Turgut

AU - Busch, David R.

AU - Nicolson, Susan C.

AU - Montenegro, Lisa M.

AU - Naim, Maryam Y.

AU - Xiao, Rui

AU - Spray, Thomas L.

AU - Yodh, A. G.

AU - Gaynor, J. William

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N2 - Objective: The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO 2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods: Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results: Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P >.05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P >.05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions: Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further.

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