Cerebral oxygenation monitoring for total arch replacement using selectivecerebral perfusion

Background. This study was undertaken to verify the safety of our total arc h replacement assisted by selective cerebral perfusion with respect to cere bral oxygenation. Methods. Subjects to be evaluated were selected between February 1999 and M arch 2000 and comprised 13 patients who underwent total arch replacement (T AR) (TAR group) and 18 patients; who had undergone coronary artery bypass g rafting or valve replacement (control group). They were monitored throughou t the operation by two-channel near-infrared spectroscopy. Changes in intra cranial oxyhemoglobin and the tissue oxygenation index were compared betwee n the two groups. Additionally, jugular venous oxygen saturation was simult aneously measured in 10 patients from each group. Maximum changes in these variables from baseline in the TAR group were compared with those in the co ntrol group. Bilateral oxygenation differences between two hemispheres were also evaluated. Results. There was no incidence of postoperative cerebral infarction, and n o significant difference was observed in the maximum decrease in these vari ables between the two groups. Bilateral oxygenation differences between the two hemispheres in the TAR group were similar to those in the control grou p, except for the tissue oxygenation index in the rewarming phase. Conclusions. From the standpoint of cerebral oxygenation, our technique of total arch replacement was nearly as safe as an ordinary cardiac operation. (C) 2001 by The Society of Thoracic Surgeons.