Monitoring of Cerebral Oxygenation by Near-infrared Spectroscopy during Cardiopulmonary Bypass in Infants

Objective: To evaluate the use of near-infrared spectroscopy for monitoring cerebral oxygenation under different cardiopulmonary bypass models. Method: Twenty-four patients with ventricular septal defect and pulmonary hypertension undergoing open-heart surgery were assigned eight each to three groups, with respect to different cardiopulmonary bypass models: moderate hypothermia cardiopulmonary bypass, deep hypothermia low flow and deep hypothermia circulatory arrest. For each patient, cerebral oxygenation with near-infrared spectroscopy were monitored and the relative concentration changes in cerebral oxygenated hemoglobin, deoxygenated hemoglobin and oxidized cytochrome aa3 were calculated. Electroencephalography, biochemical indicators such as neuron-specific enolase and lactate, and performed correlation analyses for near-infrared spectroscopy data and biochemical indicators were also measured. Results: Near-infrared spectroscopy data and biochemical indicators for moderate hypothermia cardiopulmonary bypass and deep hypothermia low flow group showed no correlation. For deep hypothermia circulatory arrest group, oxygenated hemoglobin signal declined to a plateau （nadir） during the circulatory arrest period. The duration from reaching nadir until reperfusion “oxygenated hemoglobin signal nadir-time", and the minimum values of oxygenated hemoglobin, and oxidized cytochrome aa3 were closely correlated with increasing neuron-specific enolase and lactate. And, all patients whose oxygenated hemoglobin signal nadir-time was less than 35 min were free from behavioral evidence of brain injury. Conclusion: Near-infrared spectroscopy data including oxygenated hemoglobin signal nadir-time and the minimum of oxygenated hemoglobin and oxidized cytochrome aa3 showed strong correlation with other cerebral function assessment for deep hypothermia circulatory arrest. Oxygenated hemoglobin signal nadir-time determined by near-infrared spectroscopy can be useful in predicting the safe duration of circulatory arrest.

Objective： To evaluate the use of near-infrared spectroscopy for monitoring cerebral oxygenation under different cardiopulmonary bypass models. Method： Twenty-four patients with ventricular septal defect and pulmonary hypertension undergoing open-heart surgery were assigned eight each to three groups, with respect to different cardiopulmonary bypass models： moderate hypothennia cardiopulmonary bypass, deep hypothennia low flow and deep hypothennia circulatory arrest. For each patient, cerebral oxygenation with near-infrared spectroscopy were monitored and the relative concentration changes in cerebral oxygenated hemoglobin, deoxygenated hemoglobin and oxidized cytochrome aa3 were calculated. Electroencephalography, biochemical indicators such as neuron-specific enolase and lactate, and performed correlation analyses for nearinfrared spectroscopy data and biochemical indicators were also measured. Results： Near-infrared spectroscopy data and biochemical indicators for moderate hypothennia cardiopulmonary bypass and deep hypothennia low flow group showed no correlation. For deep hypothennia circulatory arrest group, oxygenated hemoglobin signal declined to a plateau （nadir） during the circulatory arrest period. The duration from reaching nadir until reperfusion ＂oxygenated hemoglobin signal nadir-time＂, and the minimum values of oxygenated hemoglobin, and oxidized cytochrome aa3 were closely correlated with increasing neuron-specific enolase and lactate. And, all patients whose oxygenated hemoglobin signal nadir-time was less than 35 rain were free from behavioral evidence of brain injury. Conclusion： Near-infrared spectroscopy data including oxygenated hemoglobin signal nadir-time and the minimum of oxygenated hemoglobin and oxidized cytochrome aa3 showed strong correlation with other cerebral function assessment for deep hypothermia circulatory arrest. Oxygenated hemoglobin signal nadir-time determined by near-infrared spectroscopy can be useful in predicting the safe duration of circulatory arrest.