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Changes in Relative Cerebral and Renal Saturations during Stage 1 Norwood Procedure for Hypoplastic Left Heart Syndrome


, : Changes in Relative Cerebral and Renal Saturations during Stage 1 Norwood Procedure for Hypoplastic Left Heart Syndrome. Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-1285

Introduction: Stage 1 palliation (S1P) for the hypoplastic left heart syndrome (HLHS) is accomplished with significant interruptions to whole-body perfusion. Delayed reflow in the cerebral circulation has been demonstrated in neonates following deep hypothermic circulatory arrest. Recent modifications of perfusion strategies through selective cannulation have allowed the maintenance of cerebral perfusion, with unclear effects on cerebral oxygenation. This study was undertaken to examine the changes in relative cerebral and renal oxygenation (rSO2) during S1P utilizing surface reflectance oximetry (Somanetics). Methods: Nine neonates undergoing S1P for HLHS had frontal cerebral and T10 posterior (renal) reflectance probes placed shortly after induction of opioid-based anesthesia, and maintained for the duration of the procedure. Surgery was accomplished using CPB and cerebral perfusion during partial deep hypothermic circulatory arrest (PDHCA) at 15-20 degrees C with flow rate guided by rSO2. Data was logged at 1 minute intervals for subsequent analysis by repeated-measures ANOVA at different stages of S1P. Results: 5205 minutes of data was available for analysis. rSO2 pre-CPB was 69.5+-0.5 vs 63.3+-0.5 (cerebral vs. back, p<0.001); during PDHCA 79.6+-2.5 vs. 44.3+-2.4 (p<0.0001), and post-CPB 54.5+-0.3 vs 75.8+-0.3 (p<0.0001). See figure for details. Conclusions: Cerebral oxygenation is effectively maintained using selective perfusion guided by rSO2, but remains critical post CPB. Relative renal and cerebral oxygen status changes following PDHCA, with evidence of delayed reflow in the cerebral circulation despite continuous selective perfusion techniques.

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