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J Thorac Cardiovasc Surg 2005;130:830-836
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Cerebral oxygen balance is impaired during repair of aortic coarctation in infants and children

^a Department of Surgery, University of California, San Francisco, Calif.
^b Department of Anesthesia, University of California, San Francisco, Calif.
^c Department of Neurology, University of California, San Francisco, Calif.
^d Department of Pediatrics, University of California, San Francisco, Calif.

Presented at Scientific Sessions of the American Heart Association, New Orleans, La, 2004.

Received for publication February 23, 2005; revisions received April 1, 2005; accepted for publication April 12, 2005.

^_* Address for reprints: Patrick McQuillen, MD, 505 Parnassus Ave, Room M680, San Francisco, CA 94143-0106. (Email: psmcq{at}itsa.ucsf.edu).

OBJECTIVE: During repair of aortic coarctation through a left thoracotomy without cardiopulmonary bypass, clamping the proximal transverse aortic arch occludes antegrade flow to the left carotid and vertebral arteries. It is assumed that flow through the right carotid and vertebral arteries is adequate for cerebral perfusion. The study objective is to determine whether aortic occlusion impairs left hemispheric cerebral oxygen balance measured by near-infrared spectroscopy.

METHODS: In 18 children having repair of aortic coarctation, we measured the maximum change and integral for hemoglobin D (difference of oxyhemoglobin and deoxyhemoglobin), total oxygenation index, and the redox state of cytochrome aa3. Thirteen subjects had recordings from the left hemisphere to test the hypothesis that aortic occlusion impairs left hemispheric oxygen balance. Five subjects had recordings from the right hemisphere for comparison.

RESULTS: After aortic clamping, a significant decrease in hemoglobin D was observed in recordings from the left hemisphere compared with those from the right hemisphere (P = .03, maximum change in hemoglobin D). Total oxygenation index and cytochrome aa3 were generally preserved. There was an inverse linear relationship for the change in hemoglobin D during clamp application and after removal (Spearman rho = –0.74), with increased hemoglobin D after clamp removal in those subjects with the greatest decrease of hemoglobin D during arch occlusion. Linear regression analysis identified nitroprusside administration as significantly associated with a decrease in hemoglobin D (P < .001).

CONCLUSIONS: Significant impairment in left hemispheric cerebral oxygen balance was identified during arch clamping. The neurodevelopmental significance of impaired cerebral oxygen balance detected by near-infrared spectroscopy during aortic coarctation repair remains to be elucidated.

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