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DOI: 10.1055/s-0031-1297716
Monitoring of unilateral cerebral perfusion with near-infrared spectroscopy
Objectives: The aim of the study was to evaluate the usefulness of near-infrared spectroscopy (NIRS) for assessment of cerebral cross-perfusion during open aortic arch surgery with prolonged unilateral cerebral perfusion time.
Methods: Between August 2007 and August 2011, a total of 136 patients underwent open aortic arch surgery with cerebral perfusion time exceeding 20 minutes. Three patients were excluded from evaluation (in two, bilateral perfusion was used primarily due to vascular anatomo-pathology and in one, NIRS measurement failed due to technical reasons). Hence, the study comprises 133 patients (including 53 with acute type A aortic dissection), in whom unilateral cerebral perfusion was used for brain protection and the NIRS was assessed for neuromonitoring.
Results: During unilateral cerebral perfusion performed at a constant blood temperature of 28°C, the median cerebral oxygen saturation dropped on the non direct-perfused side from 66% to 60% corresponding to 91% of the baseline and remained constant throughout the perfusion time. In all but one patient, the drop was not below 40% and/or 70% of the baseline. In this one patient, an insufficient cross-over perfusion was assumed by an intense drop of the saturation to 15% (20% of the baseline) which was treated with employment of bilateral perfusion There was no association between the value of the saturation and an occurrence of permanent (5, all in acute dissections) and/or transient (10) neurological deficits.
Conclusion: The near-infrared spectroscopy seems to be a reliable instrument to assess cerebral cross-perfusion during unilateral cerebral perfusion, at least under flow and temperature management used.