Key result
Goal-directed perfusion targeting DO2i preserves aerobic metabolism during cardiopulmonary bypass in single-patient report.
Why the study?
Evidence on indexed oxygen delivery (DO₂i)-guided perfusion in obese patients undergoing redo cardiac surgery remains limited.
Does a goal-directed perfusion strategy targeting temperature-corrected DO₂i improve metabolic and clinical outcomes in an obese patient undergoing redo cardiac surgery?
Case Report (n=1)
No
Does a goal-directed perfusion strategy targeting temperature-corrected DO₂i improve metabolic and clinical outcomes in an obese patient undergoing redo cardiac surgery?
Integrating DO₂i with advanced metabolic indices and temperature-adjusted analysis can enhance predictive perfusion management and prevent complications in obese high-risk patients undergoing cardiac surgery.
May support DO₂i targeting in obese redo surgery; hypothesis-generating, requires prospective validation before adoption.
Obesity increases metabolic oxygen demand, impairs microvascular reserve, and reduces tolerance to hemodilution during cardiopulmonary bypass (CPB), making adequate indexed oxygen delivery (DO₂i) especially important. Evidence on DO₂i-guided perfusion in obese patients undergoing redo cardiac surgery remains limited. We report the case of a 61-year-old obese woman (125 kg; BSA 2.23 m²) undergoing redo mitral valve replacement and tricuspid repair. Her elevated oxygen requirements and prolonged CPB time placed her at high risk for oxygen-delivery instability. Continuous metabolic monitoring integrated DO₂i, indexed carbon-dioxide production (VCO₂i), oxygen consumption index (VO₂i), mixed venous oxygen saturation (SvO₂), temperature-corrected oxygen-extraction ratio (O₂Eri), and the DO₂/VCO₂ ratio. Because the procedure was performed at 30°C, DO₂i was adjusted using a Q₁₀-based correction to reflect reduced metabolic demand under moderate hypothermia. A goal-directed perfusion strategy targeting a temperature-corrected DO₂i ≥ 300 mL/min/m² enabled early detection and correction of transient DO₂i declines (nadir 260 mL/min/m²). Cumulative AUC-DO₂ remained <1,000 mL/min/m²/min, with minimal exposure to DO₂i <280 mL/min/m². Aerobic metabolism was preserved throughout CPB, postoperative lactate stayed low, no acute kidney injury developed, and recovery was uncomplicated. This case shows that integrating DO₂i with advanced metabolic indices and temperature-adjusted analysis can enhance predictive perfusion management in obese high-risk patients. Further research is needed to define optimal DO₂i thresholds and temperature-specific GDP strategies for this population.
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Civelek et al. (2025) conducted a case report in Obesity and redo cardiac surgery (n=1). Goal-directed perfusion strategy (temperature-corrected DO₂i ≥ 300 mL/min/m²) was evaluated on Cumulative oxygen delivery deficit (AUC-DO₂). A goal-directed perfusion strategy targeting a temperature-corrected DO₂i ≥ 300 mL/min/m² maintained cumulative AUC-DO₂ below 1,000 mL/min/m²/min and preserved aerobic metabolism during cardiopulmonary bypass.
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