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Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children
Yasunori Yagi1, Masataka Yamamoto1, Hitoshi Saito1
1Department of Anesthesiology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 0608638, Japan.
Insights
Brain oxygen saturation (rSO2) significantly increases during the Fontan procedure after the Glenn procedure in children with univentricular heart. Arterial oxygen saturation (SaO2) is the key factor influencing these rSO2 changes.
Area of Science:
- Pediatric Cardiology
- Neurosurgery
- Critical Care Medicine
Background:
- Univentricular heart requires staged surgical repair, commonly Glenn followed by Fontan procedure.
- The impact of these cardiac surgeries on brain oxygen saturation (rSO2) in children is not well understood.
- Monitoring rSO2 is crucial for assessing cerebral perfusion during complex cardiac interventions.
Purpose of the Study:
- To investigate changes in rSO2 during and after the Glenn and Fontan procedures.
- To identify factors influencing rSO2 levels in pediatric patients undergoing staged univentricular heart repair.
- To establish the relationship between rSO2 and arterial oxygen saturation (SaO2) in this population.
Main Methods:
- Retrospective analysis of rSO2 data and clinical records from 30 children.
- rSO2 measurements using INVOS 5100C at the start and end of each procedure.
- Calculation of cerebral perfusion pressure and assessment of SaO2 and hemoglobin levels.
Main Results:
- rSO2 showed a slight, insignificant increase during the Glenn procedure.
- A significant increase in rSO2 was observed during the Fontan procedure.
- SaO2 significantly increased post-Fontan, and SaO2 strongly correlated with rSO2 (r > 0.5) in both procedures.
Conclusions:
- rSO2 increases progressively with staged cardiac repair (Glenn to Fontan) in children.
- SaO2 is the primary determinant of rSO2 changes within each surgical stage.
- Further evaluation of rSO2 monitoring's significance in these pediatric cardiac surgeries is warranted.
Abstract:
Recently, it is common to perform the Fontan procedure after the Glenn procedure as surgical repair for the univentricular heart. How the brain oxygen saturation (rSO2) values change with the cardiac restoration and the process of growth during these procedures in individual children remains unknown. In this study, we retrospectively studied rSO2 data as well as the perioperative clinical records of 30 children who underwent both Glenn and Fontan procedures by the same surgeon in the same institute. The rSO2 was measured at the beginning and end of each procedure with an INVOS 5100C. Cerebral perfusion pressure was calculated by subtracting central venous pressure from mean arterial pressure. Arterial oxygen saturation (SaO2) and the hemoglobin concentration were obtained as candidates affecting rSO2 changes at the start and the end of both procedures. The rSO2 increased during the Glenn procedure, but this increase was slight and insignificant. On the other hand, the rSO2 significantly increased during the Fontan procedure. Significant increases in SaO2 were observed only between the beginning and end of the Fontan procedure. Correlation coefficients determined by linear regression analysis were more than 0.5 between rSO2 and SaO2 in both procedures. Multiple linear regression analysis showed that SaO2 was the key determinant of the rSO2. The rSO2 increases step by step from the Glenn to the Fontan procedure in the same patient. Within each procedure, SaO2 is the key determinant of the rSO2. The significance of rSO2 monitoring in these procedures should be further evaluated.
