Patel Krishna, Lussier Marc J, Dan Yongwook, Gurevich Natalie, Kunselman Allen R, Lin Tracie K, Imundo Jason R, Myers John L, Ündar Akif
Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
World J Pediatr Congenit Heart Surg. 2025 May;16(3):338-351. doi: 10.1177/21501351251322112. Epub 2025 Mar 13.
BackgroundThe objective of this study was to evaluate mean cerebral blood flow velocity, gaseous microemboli (GME) counts, regional cerebral oxygen saturation (rSO), and clinical outcomes using multimodality neuromonitoring in risk-stratified congenital cardiac surgery patients and by cyanotic and acyanotic heart disease.MethodsA total of 377 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass (CPB) were stratified by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality categories and by classification of cyanotic and acyanotic heart disease. Intraoperative mean cerebral blood flow velocity, GME counts, and rSO were assessed at multiple time points. Clinical outcomes were compared between patients of each STAT mortality category and cyanotic classification.ResultsMean cerebral blood flow velocities of STAT Mortality Category 5 patients decreased drastically from baseline values after cross-clamp (down to 56%) and after off-bypass (down to 32%), while rSO values increased significantly during CPB. Patients in STAT mortality category 5 experienced higher GME counts (1.3- to 4.4-fold greater) compared with patients in all other STAT categories. When compared with acyanotic patients, cyanotic patients experienced significantly lower mean blood flow velocity, significantly greater rSO during CPB, and greater GME counts than acyanotic patients (1.3-fold greater). Although 29 patients experienced neurological injury confirmed by electroencephalogram and magnetic resonance imaging, instances of injury were not correlated with GME counts among risk-stratified and cyanotic versus acyanotic patients.ConclusionsUtilization of intraoperative transcranial Doppler, in addition to near-infrared spectroscopy, may help to identify other parameters for cerebral protection, such as drastically decreased cerebral blood flow velocity and increased cerebral microemboli counts, particularly in STAT Mortality Category 5 and cyanotic patients.
背景
本研究的目的是使用多模态神经监测评估风险分层的先天性心脏手术患者以及患有青紫型和非青紫型心脏病患者的平均脑血流速度、气态微栓子（GME）计数、局部脑氧饱和度（rSO）和临床结局。
方法
共有377例接受体外循环（CPB）先天性心脏手术的儿科患者，根据胸外科医师协会-欧洲心胸外科学会（STAT）死亡率分类以及青紫型和非青紫型心脏病分类进行分层。在多个时间点评估术中平均脑血流速度、GME计数和rSO。比较每个STAT死亡率类别和青紫型分类患者的临床结局。
结果
STAT死亡率类别5的患者在夹闭后（降至56%）和体外循环后（降至32%）平均脑血流速度较基线值大幅下降，而rSO值在CPB期间显著增加。与所有其他STAT类别患者相比，STAT死亡率类别5的患者GME计数更高（高1.3至4.4倍）。与非青紫型患者相比，青紫型患者平均血流速度显著更低，CPB期间rSO显著更高，GME计数也比非青紫型患者更高（高1.3倍）。尽管有29例患者经脑电图和磁共振成像证实发生神经损伤，但在风险分层以及青紫型与非青紫型患者中，损伤实例与GME计数无关。
结论
除近红外光谱外，术中使用经颅多普勒可能有助于识别其他脑保护参数，如脑血流速度急剧下降和脑微栓子计数增加，特别是在STAT死亡率类别5的患者和青紫型患者中。
