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Cerebral oxygen saturation does not normalize until after stage 2 single ventricle palliation
Kathleen N Fenton1, Katherine Lessman, Kimberly Glogowski
1Department of Surgery, Children's Hospital, Omaha, Nebraska, USA. kathleennf@msn.com
Insights
Cerebral oxygen saturation (SCO2) monitoring in single ventricle heart disease reveals significant changes during palliative stages. Low postoperative SCO2 is a strong predictor of perioperative mortality in these complex pediatric cases.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cerebral Physiology
Background:
- Optimizing neurologic outcomes in single ventricle congenital heart disease (SV-CHD) necessitates monitoring cerebral oxygen saturation (SCO2).
- The relationship between SCO2 and the stage of palliative care in SV-CHD requires further investigation.
Purpose of the Study:
- To investigate the correlation between cerebral oxygen saturation (SCO2) and the specific stage of palliative surgery in pediatric patients with single ventricle congenital heart disease.
- To determine if SCO2 levels can predict perioperative mortality in this vulnerable population.
Main Methods:
- Continuous intraoperative cerebral oxygen saturation (SCO2) monitoring was performed in 34 infants and children undergoing palliative surgery for SV-CHD.
- A control group of 12 neonates with ductus-dependent circulation undergoing complete repair was also studied.
- SCO2 data were correlated with the patient's palliative stage and clinical outcomes, including perioperative mortality.
Main Results:
- Baseline SCO2 varied significantly across palliative stages, being lowest (41%) in infants undergoing interstage operations.
- Post-bypass, SCO2 improved in stage 2 palliation infants (53%), but decreased significantly by the end of surgery in neonates (48%).
- Cerebral oxygen saturation at the conclusion of surgery was significantly lower in patients who died (38%) compared to survivors (61%).
Conclusions:
- In children with single ventricle physiology, SCO2 demonstrates a dynamic pattern, decreasing after initial palliation and remaining low before second-stage palliation.
- SCO2 levels normalize before and after the Fontan procedure.
- Low postoperative cerebral oxygen saturation is a significant predictor of perioperative mortality and has implications for neurologic injury and interim mortality.
Background:
In an effort to optimize neurologic outcome, cerebral oxygen saturation (SCO2) is often measured intraoperatively and postoperatively. We hypothesized that SCO2 would be related to stage of palliation in children with single ventricle congenital heart disease.
Methods:
Cerebral oxygen saturation was continuously recorded intraoperatively in 34 infants and children undergoing palliative surgery on cardiopulmonary bypass for single ventricle congenital heart defects and in a control group of 12 neonates with ductus-dependent circulation undergoing complete repair. Saturations were correlated with the patient's stage and outcome.
Results:
Baseline SCO2 was 61% in single ventricle neonates (group P1, n = 10), 55% in neonates undergoing repair (group R), 42% in infants undergoing stage 2 palliation (group P2, n = 6), and 70% in children undergoing Fontan (group P3, n = 14). Baseline was lowest (41%) in infants undergoing interstage operations (group I, n = 4). After bypass, there was a significant improvement in SCO2 to 53% in group P2 infants (p = 0.04); there were no significant changes in the other groups. By the end of the operation, there was a significant decrease in SCO2 to 48% in group P1 (p = 0.001), with other groups unchanged from baseline. There were five perioperative deaths. Cerebral oxygen saturation at the conclusion of surgery was lower in children who died (38% versus 61%, p = 0.01).
Conclusions:
In children with single ventricle physiology, SCO2 decreases after initial palliation, remains low before second-stage palliation, but is normal before and after the Fontan. This has implications for perioperative mortality, neurologic injury, and potentially for interim mortality. Low postoperative SCO2 predicts perioperative mortality.
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