Effective cerebral protection using near-infrared spectroscopy monitoring with antegrade cerebral perfusion during aortic surgery

Abstract Objective: Antegrade cerebral perfusion (ACP) under moderate hypothermia may improve cerebral protection. Intraoperative measurement of cerebral regional oxygen saturations (rSO2) using near‐infrared spectroscopy (NIRS) can provide accurate monitoring of cerebral perfusion during ACP. We evaluated the role, outcomes, and advantages of using NIRS in providing effective cerebral protection with ACP. Methods: Between May 2006 and March 2009, 27 patients (mean age 60%, 93% elective) underwent ascending aorta replacement with ACP monitored by NIRS. ACP was established through the right axillary artery (n = 26). All patients had continuous intraoperative measurement of both anterior cerebral rSO2 using NIRS (INVOS; Somanetics Corporation, Troy, MI, USA). Posterior cerebral perfusion was measured using left radial artery pressures. Quality of life (QoL) was assessed using a Short Form 36 questionnaire. Results: Mean cardiopulmonary bypass and aortic cross clamp time were 169 ± 27 and 95 ± 22 minutes, respectively. Mean ACP rate of 1.27 ± 0.35 L/min provided a mean left radial artery pressure of at least 60 mmHg. All patients’ cerebral rSO2 were maintained above their baseline using NIRS. Mean ACP time was 14.3 ± 2.6 minutes at a mean core temperature of 23.4 °C ± 2.0 °C. Temporary neurological deficit was observed in two patients (7.4%). No permanent neurological dysfunction was observed. Thirty‐day mortality was 3.7%. At median follow‐up of 18.3 (interquartile range 10.8 to 23.3) months survival was 92% and mean norm‐based QoL score was above average at 52.5 ± 6.5. Conclusion: Cerebral rSO2 and left radial artery pressure monitoring with ACP during aortic surgery provides accurate measurement of cerebral perfusion resulting in minimal neurological and perioperative complications and good midterm QoL outcomes.