Cerebral Oximetry Monitoring in Patients Undergoing Surgery for Stanford Type A Aortic Dissection

Objectives

The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO₂) in patients undergoing surgery for Stanford type A aortic dissection (TAAD).

Design

Observational, retrospective, institutional study.

Setting

University hospital.

Participants

A total of 152 patients who underwent surgery for TAAD from June 2009 to December 2018 at the authors’ institution.

Interventions

Surgery for TAAD using continuous perioperative monitoring of crSO₂ with near-infrared cerebral oximetry (INVOS, Medtronic, MN).

Measurements and Results

The rates of postoperative stroke/global brain ischemia were 22.4% and of hospital mortality 14.5%. Age, hemoglobin, and cardiogenic shock were independent predictors of nadir crSO₂ from both frontal areas at arrival to the operating room. Repeated measures test showed that changes in crSO₂ between the first measurement at operating room arrival, at the start of surgery, and at the end of surgery were not significant when measured on the right frontal area (p = 0.632), left frontal area (p = 0.608), as a nadir value from both frontal areas (p = 0.690), and as a difference between frontal areas (p = 0.826) in patients with and without major neurologic complications. Patients who had a nadir crSO₂ <40% anytime during the perioperative period, had a numerically higher rate of major neurologic complications (27.3% v 20.4%, p = 0.354), but this difference did not reach statistical significance. The incidence of nadir of crSO₂ value <40% at operating room arrival (5.9%, p = 1.000), at the start of surgery (5.3%, p = 0.685), and at the end of surgery (1.3%, p = 1.000) was rather low and not associated with these adverse events.

Conclusions

Derangements in crSO₂ detected by cerebral oximetry before and during surgery for TAAD did not predict postoperative stroke and/or global brain ischemia.