Intraoperative Cerebral Desaturation during Neonatal Congenital Heart Surgery is Associated with Perioperative Brain Changes but not with Neurodevelopmental Outcome at 1 Year of Age

Background: The impact of intraoperative cerebral desaturation (CD) measured by near-infrared spectroscopy (NIRS) to predict neurodevelopment (ND) in neonates with severe congenital heart disease (CHD) is of interest. The aim of this study was to compare perioperative MR brain changes and ND outcome in patients with and without intraoperative CD.

Method: Neonates requiring congenital heart surgery were enrolled in a prospective cohort study. NIRS data of their first cardiac surgery performed at 14.4 ± 5.8 days of life were collected. Brain volumes and intracranial lesions were analyzed in pre- and postoperative magnetic resonance imaging (MRI) scans performed within a range of 19.3 ± 7.1 days. Perioperative structural changes and ND outcome (Bayley's scales III) at 1 year were compared between patients with and without CD using two NIRS thresholds: 45% rSO₂ and 20% BLrSO₂.

Results: Thirty-two patients (72% male) with d-transposition of the great arteries (n = 24, 75%) and other complex types of CHD (n = 8, 25%) were analyzed. Perioperative relative lateral brain ventricle volume (LBVV) change was higher in patients with intraoperative CD compared with patients without (p = 0.003 for 45% rSO₂, p = 0.008 for 20% BLrSO₂), for 45% rSO₂ threshold even after adjusting for age at postoperative MRI, time between MRI and cardiac diagnosis (p = 0.019). New postoperative intracranial lesions occurred predominantly in CD groups (all six patients for 45% rSO₂ and five of six patients for 20% BLrSO₂). ND outcome at 1 year was not associated with intraoperative CD.

Conclusion: This study demonstrates the impact of intraoperative NIRS cerebral desaturation associated with perioperative MR brain changes at different thresholds but not with ND outcome at 1 year of age.

Publication History

Article published online:
12 February 2022