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J Thorac Cardiovasc Surg 2006;131:1099-1107
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Inclusion of oxygen consumption improves the accuracy of arterial and venous oxygen saturation interpretation after the Norwood procedure

Cardiac Program, the Hospital for Sick Children, Toronto, Ontario, Canada

Read at the Eighty-fifth Annual Meeting of The American Association of Thoracic Surgery, San Francisco, Calif, April 10–13, 2005.

Received for publication April 8, 2005; revisions received October 5, 2005; accepted for publication October 10, 2005.

^_* Address for reprints: Glen S. Van Arsdell, MD, Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8 (Email: glen.vanarsdell{at}sickkids.ca).

OBJECTIVE: Management strategy for the postoperative Norwood neonate has been formulated from models that have estimated oxygen consumption (VO ₂). Superior vena caval oxygen saturation (SVO ₂), systemic arterial and superior vena caval oxygen saturation difference (Sa-VO ₂), and oxygen excess factor ( = arterial oxygen saturation/Sa-VO ₂) have been used as indirect indicators to estimate systemic blood flow (Qs) and oxygen delivery (DO ₂). We sought to examine the correlation of the indirect indicators to VO ₂-derived measures of oxygen transport.

METHODS: Respiratory mass spectrometry was used to continuously measure VO ₂ after the Norwood procedure (n = 13). Measured saturations and the direct Fick equation were used to obtain pulmonary blood flow, Qs, DO₂, and oxygen extraction ratio (ERO ₂) values. Correlations to SVO ₂, Sa-VO ₂, and were sought.

RESULTS: There was a close correlation of SVO ₂, Sa-VO ₂, and to ERO ₂ (r = 0.92, 0.96, and 0.97, respectively; P < .0001). Correlation to Qs and DO ₂ was variable (r = 0.39 to 0.78, respectively; P < .0001). Correlation to VO ₂ was poor but significant (r = 0.24 to 0.40, P < .0001). Inclusion of VO ₂ improved the correlation to Qs and DO ₂ (r = 0.66 to 0.97, P < .0001).

CONCLUSIONS: The close correlation of SVO ₂, Sa-VO ₂, and to ERO ₂ indicates that each is a measure of the balance of DO ₂ and extraction. The significant but less reliable correlation to DO ₂ and VO ₂ indicates the values for SVO ₂, Sa-VO ₂, and do not discriminate between the contribution of DO ₂ and VO ₂. Measured VO ₂ and hemodynamics may improve the optimization of postoperative management strategy in the individual neonate.

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