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Monitoring the brain before, during, and after cardiac surgery to improve long-term neurodevelopmental outcomes

Published online by Cambridge University Press:  13 October 2006

Nancy S. Ghanayem ,
Michael E. Mitchell ,
James S. Tweddell  and
George M. Hoffman
Nancy S. Ghanayem
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Wisconsin, United States of America Division of Critical Care, Medical College of Wisconsin, Wisconsin, United States of America Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
Michael E. Mitchell
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Wisconsin, United States of America Herma Heart Center at Children's Hospital of Wisconsin, Wisconsin, United States of America Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
James S. Tweddell
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Wisconsin, United States of America Herma Heart Center at Children's Hospital of Wisconsin, Wisconsin, United States of America Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
George M. Hoffman
Affiliation:
Division of Critical Care, Medical College of Wisconsin, Wisconsin, United States of America Department of Anesthesia, Medical College of Wisconsin, Wisconsin, United States of America Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Abstract

Innovation in surgical and medical management of cardiac disease has generated a dramatic improvement in operative survival. Along with these favourable results in terms of survival is the heightened awareness of neurologic complications, which often become evident beyond the early postoperative period. A large, multicentre prospective study found serious neurologic injury occurs in about one-twentieth of patients after myocardial revascularization in adults.1 More subtle evidence of persistent cognitive decline and functional impairment has been shown to occur in over two-fifths of such patients.2 Acute neurologic abnormalities are reported in up to one-fifth of infants and children who undergo cardiac surgery.3–6 Lasting impairments in cognitive, motor, and expressive functioning have been reported in up to three-fifths of children who have undergone complex cardiac surgery during infancy.7 Specifically, gross and fine motor delays, visual-spatial problems, language deficits and long-term emotional and behavioural problems have been found.8–13

Keywords

Venous oximetrynear infrared spectroscopytranscranial Dopplerelectroencephalographyrisk factors
Type
Long-term Outcomes
Information
Cardiology in the Young , Volume 16 , Supplement S3: Controversies and Challenges of the Atrioventricular Junctions and Other Challenges Facing Paediatric Cardiovascular Practitioners and their Patients , September 2006 , pp. 103 - 109
Copyright
© 2006 Cambridge University Press

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References

Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 35: 1857–1863.Google Scholar
Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395–402.Google Scholar
Newburger JW, Jonas RA, Wernovsky G, et al. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993; 329: 1057–1064.Google Scholar
Fallon P, Aparicio JM, Elliott MJ, Kirkham FJ. Incidence of neurological complications of surgery for congenital heart disease. Arch Dis Child 1995; 72: 418–422.Google Scholar
Austin EH 3rd, Edmonds HL Jr, Auden SM, et al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg 1997; 114: 707–717.Google Scholar
Menache CC, Du Plessis AJ, Wessel DL, Jonas RA, Newburger JW. Current incidence of acute neurologic complications after open-heart operations in children. Ann Thorac Surg 2002; 73: 1752–1758.Google Scholar
Miller G, Tesman JR, Ramer JC, Baylen BG, Myers JL. Outcome after open-heart surgery in infants and children. J Child Neurol 1996; 11: 49–53.Google Scholar
Bellinger DC, Jonas RA, Rappaport LA, et al. Developmental and neurologic status of children after open heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 1995; 332: 549–555.Google Scholar
Du Plessis AJ. Neurologic complications of cardiac disease in the newborn. Clin Perinatol 1997; 24: 807–826.Google Scholar
Bellinger DC, Rappaport LA, Wypyij D, Wernovsky G, Newburger JW. Patterns of developmental dysfunction after surgery during infancy to correct transposition of the great arteries. J Dev Behav Pediatr 1997; 18: 75–83.Google Scholar
Limperopoulos C, Majnemer A, Shevell MI, et al. Functional limitations in young children with congenital heart defects after surgery. Pediatr 2001; 108: 1325–1331.Google Scholar
Limperopoulos C, Majnemer A, Shevell MI, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141: 51–58.Google Scholar
Majnemer A, Limperopoulos C, Shevell M, Rohlicek C, Rosenblatt B, Tchervenkov C. Health and well-being of children with congenital cardiac malformations, and their families, following open-heart surgery. Cardiol Young 2006; 16: 157–164.Google Scholar
Bellinger DC, Wypij D, du Plessis AJ, et al. Developmental and neurologic status of children at 4 years after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526–532.Google Scholar
Bellinger DC, Wypij D, du Plessis AJ, et al. Neurodevelopmental status at eight years in children with destroy-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1385–1396.Google Scholar
Wypij D, Newburger JW, Rappaport LA, et al. The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1397–1403.Google Scholar
Clancy RR, McGaurn SA, Wernvosky G, et al. Risk of seizures of newborn heart surgery using deep hypothermic circulatory arrest. Pediatr 2003; 111: 592–601.Google Scholar
Gaynor JW, Gerdes M, Zackai E, et al. Apolipoprotein E genotype and neurodevelopmental sequelae of infant cardiac surgery. J Thorac Cardiovasc Surg 2003; 126: 1736–1745.Google Scholar
Licht DJ, Wang J, Silvestre DW, et al. Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects. J Thorac Cardiovasc Surg 2004; 128: 841–849.Google Scholar
Mahle WT, Wernovsky G. Neurodevelopmental outcomes in hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 39–47.Google Scholar
Mahle WT, Tavani F, Zimmerman RA, et al. A MRI study of neurologic injury before and after congenital heart surgery. Circulation 2002; 106: I109–I114.Google Scholar
Miller SP, McQuillen PS, Vigneron DB, et al. Preoperative brain injury in newborns with transposition of the great arteries. Ann Thorac Surg 2004; 77: 1698–1706.Google Scholar
Dent CL, Spaeth JP, Jones BV, et al. Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion. J Thorac Cardiovasc Surg 2006; 131: 190–197.Google Scholar
Hoffman GM, Ghanayem NS, Kampine JM, et al. Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann Throrac Surg 2000; 70: 1515–1520.Google Scholar
Hoffman GM, Mussatto KA, Brosig CL, et al. Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2005; 130: 1094–1100.Google Scholar
Daubeney PE, Pilkington SN, Janke E, Charlton GA, Smith DC, Webber SA. Cerebral oxygenation measured by near-infrared spectroscopy: comparison with jugular bulb oximetry. Ann Thorac Surg 1996; 61: 90–94.Google Scholar
Pollard V, Prough DS, DeMelo AE, Deyo DJ, Uchida T, Stoddart HF. Validation in volunteers of a near-infrared spectroscope for monitoring brain oxygenation in vivo. Anesth Analg 1996; 82: 269–277.Google Scholar
Watzman HM, Kurth DM, Montenegro LM, Rome J, Steven JM, Nicholson SC. Arterial and venous contributions to near infrared cerebral oximetry. Anesthesiology 2000; 93: 947–953.Google Scholar
Kim MB, Ward DS, Cartwright CR, Kolano J, Chlebowski S, Henson LC. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit 2000; 16: 191–199.Google Scholar
Kurth DM, Steven JL, Montenegro LM, et al. Cerebral oxygen saturation before congenital heart surgery. Ann Thorac Surg 2001; 72: 187–192.Google Scholar
Fenton KN, Freeman K, Glogowski K, Fogg S, Duncan KF. The significance of baseline cerebral oxygen saturation in children undergoing congenital heart surgery. Am J Surg 2005; 190: 260–263.Google Scholar
Levy WJ, Levin S, Chance B. Near-infrared measurement of cerebral oxygenation. Correlation with electroencephalographic ischemia during ventricular fibrillation. Anesthesiology 1995; 83: 738–746.Google Scholar
Kurth CD, Levy WJ, McCann J. Near-infrared spectroscopy cerebral oxygen saturation thresholds for hypoxia-ischemia in piglets. J Cereb Blood Flow Metab 2002; 22: 335–341.Google Scholar
Kurth CD, Steven JM, Nicolson SC. Cerebral oxygenation during pediatric cardiac surgery using deep hypothermic circulatory arrest. Anesthesiology 1995; 82: 74–82.Google Scholar
Du Plessis AJ. Mechanisms of brain injury during infant cardiac surgery. Semin Pediatr Neurol 1999; 6: 32–47.Google Scholar
Sakamoto T, Jonas RA, Stock UA, et al. Utility and limitations of near-infrared spectroscopy during cardiopulmonary bypass in a piglet model. Pediatr Res 2001; 49: 770–776.Google Scholar
Sakamoto T, Zurakowski D, Duebener LF, et al. Interaction of temperature with hematocrit level and pH determines safe duration of hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2004; 128: 220–232.Google Scholar
Edmonds HL, Ganzel BL, Austin 3rd. EH Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac and Vascular Anesthesia 2004; 8: 147–166.Google Scholar
Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg 2005; 101: 740–747.Google Scholar
Murkin JM, Adams S, Schaefer B, et al. Monitoring cerebral oxygen saturation significantly decreases major organ morbidity in CABG patients: A randomized blinded study. Heart Surg Forum 2004; 7: 515.Google Scholar
Hoffman GM. Detection and prevention of neurologic injury in the intensive care unit. Cardiol Young 2005; 15(suppl 1): I149–I153.Google Scholar
Ramamoorthy C, Tabbutt S, Kurrth CD, et al. Effects of inspired hypoxic and hypercapnic gas mixtures on cerebral oxygen saturation in neonates with univentricular heart defects. Anesthesiology 2002; 96: 283–288.Google Scholar
Greeley WJ, Ungerleider RM, Kern FH, et al. Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants and children. Circulation 1999; 80: 1209–1215.Google Scholar
Hillier SC, Burrows FA, Bissonnette B, Taylor RH. Cerebral hemodynamics in neonates and infants undergoing cardiopulmonary bypass and profound hypothermic circulatory arrest: assessment by transcranial Doppler sonography. Anesth Analg 1991; 72: 723–728.Google Scholar
Zimmerman AA, Burrows FA, Jonas RA, Hickey PR. The limits of detectable cerebral perfusion by transcranial Doppler sonography in neonates undergoing low-flow cardiopulmonary bypass. J Thorac Cardiovasc Surg 1997; 114: 594–600.Google Scholar
Andropoulos DB, Stayer SA, McKenzie ED, et al. Novel cerebral physiologic monitoring to guide low-flow cerebral perfusion during neonatal arch reconstruction. J Thorac Cardiovasc Surg 2003; 125: 491–499.Google Scholar
Carbutti G, Romand JA, Carballo JS, Bendjelid SM, Suter PM, Bendjelid K. Transcranial Doppler: an early predictor of ischemic stroke after cardiac arrest? Anesth Analg 2003; 97: 1262–1265.Google Scholar
Fearn SJ, Pole R, Wesnes K, Faragher EB, Hooper TL, McCollum CN. Cerebral injury during cardiopulmonary bypass: emboli impair memory. J Thorac Cardiovasc Surg 2001; 121: 1150–1160.Google Scholar
Abu-Omar Y, Cifelli A, Matthews PM, Taggart DP. The role of microembolism in cerebral injury as defined by functional magnetic resonance imaging. Eur J Cardiothorac Surg 2004; 26: 586–591.Google Scholar
Rappaport LA, Wypij D, Bellinger DC, et al. Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Circulation 1998; 97: 773–779.Google Scholar
Gaynor JW, Jarvik GP, Bernbaum J, et al. The relationship of electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery. J Thorac Surg 2006; 131: 181–189.Google Scholar
Gaynor JW, Nicolson SC, Jarvik GP, et al. Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures. J Thorac Surg 2005; 130: 1278–1286.Google Scholar
Helmers SL, Wypij D, Constantinou JE, et al. Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects. Electroencephalogr Clin Neurophysiol 1997; 102: 27–36.Google Scholar
Yeh Jr, T Austin EH III, Sehic A, Edmonds Jr. HL Rapid recognition and treatment of cerebral air embolism: The role of neuromonitoring. J Thorac Cardiovasc 2003; 126: 589–591.Google Scholar