HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jennifer C. Hirsch Richard G. Ohye Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hirsch, J. C. Articles by Gurney, J. G. Search for Related Content PubMed Articles by Hirsch, J. C. Articles by Gurney, J. G. Related Collections Cerebral protection Congenital - acyanotic Congenital - cyanotic

J Thorac Cardiovasc Surg 2009;137:154-159
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Near-infrared spectroscopy: What we know and what we need to know—A systematic review of the congenital heart disease literature

^a Department of Surgery, Section of Cardiac Surgery, Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Mich
^b Department of Pediatrics, Section of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Mich
^c Department of Pediatrics, Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Mich

Received for publication January 9, 2008; revisions received May 5, 2008; accepted for publication August 2, 2008.

^_* Address for reprints: Jennifer C. Hirsch, MD, 5144 Cardiovascular Center, Ann Arbor, MI 48109-5864. (Email: jhirsch{at}umich.edu).

Objectives: Neurologic dysfunction is a problem in patients with congenital heart disease. Near-infrared spectroscopy may provide a real-time window into cerebral oxygenation. Enthusiasm for near-infrared spectroscopy has increased hopes of reducing neurologic dysfunction. However, potential gains need to be evaluated relative to cost before routine implementation. Responding to data in ways that seem intuitively beneficial can be risky when the long-term impact is unknown. Thus, we performed a systematic review of the literature on near-infrared spectroscopy in congenital heart disease.

Methods: A literature search from 1950 to April 2007 for near-infrared spectroscopy in congenital heart disease was undertaken. We identified 54 manuscripts and\ 13 reviews.

Results: There were 47 case series, 4 randomized trials, and 3 retrospective studies. Two studies had postdischarge follow-up, one incorporating neurologic testing. Neither of these studies demonstrated a benefit. One retrospective study, which included near-infrared spectroscopy and other intraoperative measures of cerebral perfusion, demonstrated a decrease in neurologic dysfunction using this combination of monitors. Three small studies were able to correlate near-infrared spectroscopy with other clinical and radiologic findings.

Conclusions: Many centers, and even entire countries, have adopted near-infrared spectroscopy as standard of care. The available data suggest that multimodality monitoring, including near-infrared spectroscopy, may be a useful adjunct. The current literature on the use of near-infrared spectroscopy alone, however, does not demonstrate improvement in neurologic outcome. The data correlating near-infrared spectroscopy findings with indirect measures of neurologic outcome or mortality are limited. Although near-infrared spectroscopy has promise for measuring regional tissue oxygen saturation, the lack of data demonstrating improved outcomes limits the support for widespread implementation.