• J. Thorac. Cardiovasc. Surg. · Oct 2018

    Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease.

    • Jennifer M Lynch, Tiffany Ko, David R Busch, John J Newland, Madeline E Winters, Kobina Mensah-Brown, Timothy W Boorady, Rui Xiao, Susan C Nicolson, Lisa M Montenegro, J William Gaynor, Thomas L Spray, Arjun G Yodh, Maryam Y Naim, and Daniel J Licht.
    • Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Penn. Electronic address: lynchj3@email.chop.edu.
    • J. Thorac. Cardiovasc. Surg. 2018 Oct 1; 156 (4): 165716641657-1664.

    BackgroundHypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk.MethodsNeonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model.ResultsForty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period.ConclusionsIn neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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