Abstract 19783: Cerebral Oxygenation on Morning of Surgery Dependent on Time-to-Surgery in Infants with Critical Congenital Heart Disease
Introduction: Infants with critical congenital heart disease exhibit a high prevalence of hypoxic-ischemic white matter injury (WMI). Infants with transposition of the great arteries (TGA) have a greater risk for pre-operative injury, whereas infants with hypoplastic left heart syndrome (HLHS) have post-operative injury. Recent work has shown that increasing time from birth to surgery increases these risks for WMI in both cohorts. Understanding the changing preoperative cerebral physiology will help shed light on the differences in the timing of injury between diagnoses.
Methods: Term neonates with TGA or HLHS were recruited. Frequency domain diffuse optical spectroscopy and diffuse correlation spectroscopy were employed to noninvasively quantify cerebral oxygen saturation (ScO2) and cerebral blood flow (CBF) prior to surgery. Cerebral oxygen extraction fraction (OEF) was calculated from ScO2 and arterial oxygen saturation from arterial blood gases. Subjects were grouped by time-to-surgery, with one group undergoing surgery prior to day-of-life 4 and the other on day-of-life 4 or later.
Results: We studied 48 neonates diagnosed with either HLHS (N=30) or TGA (N=18). Anthropometric data were similar. Infants who went to surgery on day-of-life 4 or later had a significantly higher OEF (p < 0.01 (HLHS) and p = 0.02 (TGA)). There was no difference in CBF between groups in either diagnosis.
Conclusions: In patients with TGA, oxygen is limited only by decreased systemic oxygen levels, whereas in HLHS, oxygen delivery to the brain is limited by decreased blood flow in the aortic arch and, to a lesser extent, decreased systemic oxygenation. These results suggest that increasing cerebral oxygen demand preoperatively underlies the reported increased risk for WMI in infants with TGA and HLHS. The difference in timing of WMI between these diagnoses is more likely due to differences in cerebral oxygen delivery than metabolic demand.
- Congenital heart disease
- Pediatric cardiac intensive care
- Congenital heart surgery
- Pediatric cardiology
Author Disclosures: J.M. Lynch: None. M.Y. Naim: None. E.M. Buckley: None. M.E. Winters: None. P.J. Schwab: None. D.R. Busch: None. A.L. McCarthy: None. T.S. Ko: None. R. Xiao: None. S.C. Nicolson: None. L.M. Montenegro: None. S. Fuller: None. J. Gaynor: None. T.L. Spray: None. A.G. Yodh: None. D.J. Licht: None.
- © 2014 by American Heart Association, Inc.