Key result
High-risk pediatric patients in STAT Mortality Category 5 experienced drastically decreased cerebral blood flow velocity and 1.3- to 4.4-fold higher gaseous microemboli counts during cardiopulmonary bypass compared to lower-risk patients.
Why the study?
The study evaluated mean cerebral blood flow velocity, gaseous microemboli counts, regional cerebral oxygen saturation, and clinical outcomes via multimodality neuromonitoring in congenital cardiac surgery patients stratified by risk and cyanotic status.
Does multimodality neuromonitoring identify differences in cerebral hemodynamics and microemboli among risk-stratified pediatric patients undergoing congenital cardiac surgery?
Observational (n=377)
No
Does multimodality neuromonitoring identify differences in cerebral hemodynamics and microemboli among risk-stratified pediatric patients undergoing congenital cardiac surgery?
Effect estimate: 1.3- to 4.4-fold greater
High-risk and cyanotic pediatric patients undergoing cardiac surgery exhibit significantly compromised cerebral blood flow and higher microemboli counts, highlighting the potential value of multimodality neuromonitoring.
Background The objective of this study was to evaluate mean cerebral blood flow velocity, gaseous microemboli (GME) counts, regional cerebral oxygen saturation (rSO 2 ), and clinical outcomes using multimodality neuromonitoring in risk-stratified congenital cardiac surgery patients and by cyanotic and acyanotic heart disease. Methods A total of 377 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass (CPB) were stratified by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality categories and by classification of cyanotic and acyanotic heart disease. Intraoperative mean cerebral blood flow velocity, GME counts, and rSO 2 were assessed at multiple time points. Clinical outcomes were compared between patients of each STAT mortality category and cyanotic classification. Results Mean cerebral blood flow velocities of STAT Mortality Category 5 patients decreased drastically from baseline values after cross-clamp (down to 56%) and after off-bypass (down to 32%), while rSO 2 values increased significantly during CPB. Patients in STAT mortality category 5 experienced higher GME counts (1.3- to 4.4-fold greater) compared with patients in all other STAT categories. When compared with acyanotic patients, cyanotic patients experienced significantly lower mean blood flow velocity, significantly greater rSO 2 during CPB, and greater GME counts than acyanotic patients (1.3-fold greater). Although 29 patients experienced neurological injury confirmed by electroencephalogram and magnetic resonance imaging, instances of injury were not correlated with GME counts among risk-stratified and cyanotic versus acyanotic patients. Conclusions Utilization of intraoperative transcranial Doppler, in addition to near-infrared spectroscopy, may help to identify other parameters for cerebral protection, such as drastically decreased cerebral blood flow velocity and increased cerebral microemboli counts, particularly in STAT Mortality Category 5 and cyanotic patients.
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Patel et al. (2025) conducted an observational in Congenital heart disease requiring surgical correction with cardiopulmonary bypass (n=377). High STAT mortality category (Category 5) and cyanotic heart disease vs. Lower STAT mortality categories (1-4) and acyanotic heart disease was evaluated on Gaseous microemboli (GME) counts during cardiopulmonary bypass (1.3- to 4.4-fold greater). High-risk pediatric patients in STAT Mortality Category 5 experienced drastically decreased cerebral blood flow velocity and 1.3- to 4.4-fold higher gaseous microemboli counts during cardiopulmonary bypass compared to lower-risk patients.
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