• Stefano Pezzato, Rathinaswamy B Govindan, Francesca Bagnasco, Eleni Marie Panagopoulos, Chiara Robba, Erta Beqiri, Peter Smielewski, Ricardo A Munoz, Yves d'Udekem, Andrea Moscatelli, and Adre du Plessis.
• Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC. Electronic address: stefanopezzato@gaslini.org.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 1; 168 (2): 353363.e4353-363.e4.

ObjectiveTo investigate whether cerebral autoregulation is impaired after neonatal cardiac surgery and whether changes in autoregulation metrics are associated with different congenital heart defects or the incidence of postoperative neurologic events.MethodsThis is a retrospective observational study of neonates undergoing monitoring during the first 72 hours after cardiac surgery. Archived data were processed to calculate the cerebral oximetry index (COx) and derived metrics. Acute neurologic events were identified by an electronic medical record review. The Skillings-Mack test and the Wilcoxon signed-rank test were used to analyze the evolution of autoregulation metrics over time; the Mann-Whitney U test was used for comparison between groups.ResultsWe included 28 neonates, 7 (25%) with hypoplastic left heart syndrome and 21 (75%) with transposition of the great arteries. Overall, the median percentage of time spent with impaired autoregulation, defined as percentage of time with a COx >0.3, was 31.6% (interquartile range, 21.1%-38.3%). No differences in autoregulation metrics between different cardiac defects subgroups were observed. Seven patients (25%) experienced a postoperative acute neurologic event. Compared to the neonates without an acute neurologic event, those with an acute neurologic event had a higher COx (0.16 vs 0.07; P = .035), a higher percentage of time with a COx >0.3 (39.4% vs 29.2%; P = .017), and a higher percentage of time with a mean arterial pressure below the lower limit of autoregulation (13.3% vs 6.9%; P = .048).ConclusionsCOx monitoring after cardiac surgery allowed for the detection of impaired cerebral autoregulation, which was more frequent in neonates with postoperative acute neurologic events.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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