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Impact of the superior cavopulmonary anastomosis on cerebral oxygenation
Patients with univentricular heart disease may undergo a superior cavopulmonary anastomosis, an operative intervention that raises cerebral venous pressure and impedance to cerebral venous return. The ability of infantile cerebral autoregulation to compensate for this is not well understood. We iden...
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| Published in: | Cardiology in the young 2020-04, Vol.30 (4), p.585-587 |
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| creator | Thatte, Nikhil Zhou, Lingyu Kheir, John N |
| description | Patients with univentricular heart disease may undergo a superior cavopulmonary anastomosis, an operative intervention that raises cerebral venous pressure and impedance to cerebral venous return. The ability of infantile cerebral autoregulation to compensate for this is not well understood.
We identified all patients undergoing a superior cavopulmonary anastomosis (cases) and compared metrics of cerebral oxygenation upon admission to the ICU with patients following repair of tetralogy of Fallot or arterial switch operation (controls). The primary endpoint was cerebral venous oxyhaemoglobin saturation measured from an internal jugular venous catheter. Other predictor variables included case-control assignment, age, weight, sex, ischemic times, arterial oxyhaemoglobin saturation, mean arterial blood pressure, and superior caval pressure.
A total of 151 cases and 350 controls were identified. The first post-operative cerebral venous oxyhaemoglobin saturation was significantly lower following superior cavopulmonary anastomosis than in controls (44 ± 12 versus 59 ± 15%, p < 0.001), as was arterial oxyhaemoglobin saturation (81 ± 9 versus 98 ± 5%, p < 0.001). Cerebral venous oxyhaemoglobin saturation correlated poorly with superior caval pressure in both groups. When estimated by linear mixed effects model, arterial oxyhaemoglobin saturation was the primary determinant of central venous oxyhaemoglobin saturation in both groups (β = 0.79, p = 3 × 10-14); for every 1% point increase in arterial oxyhaemoglobin saturation, there was a 0.79% point increase in venous oxyhaemoglobin saturation. In this model, no other predictors were significant, including superior caval pressure and case-control assignment.
Cerebral autoregulation appears to remain intact despite acute imposition of cerebral venous hypertension following superior cavopulmonary anastomosis. Following superior cavopulmonary anastomosis, cerebral venous oxyhaemoglobin saturation is primarily determined by arterial oxyhaemoglobin saturation. |
| doi_str_mv | 10.1017/S1047951120000517 |
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We identified all patients undergoing a superior cavopulmonary anastomosis (cases) and compared metrics of cerebral oxygenation upon admission to the ICU with patients following repair of tetralogy of Fallot or arterial switch operation (controls). The primary endpoint was cerebral venous oxyhaemoglobin saturation measured from an internal jugular venous catheter. Other predictor variables included case-control assignment, age, weight, sex, ischemic times, arterial oxyhaemoglobin saturation, mean arterial blood pressure, and superior caval pressure.
A total of 151 cases and 350 controls were identified. The first post-operative cerebral venous oxyhaemoglobin saturation was significantly lower following superior cavopulmonary anastomosis than in controls (44 ± 12 versus 59 ± 15%, p < 0.001), as was arterial oxyhaemoglobin saturation (81 ± 9 versus 98 ± 5%, p < 0.001). Cerebral venous oxyhaemoglobin saturation correlated poorly with superior caval pressure in both groups. When estimated by linear mixed effects model, arterial oxyhaemoglobin saturation was the primary determinant of central venous oxyhaemoglobin saturation in both groups (β = 0.79, p = 3 × 10-14); for every 1% point increase in arterial oxyhaemoglobin saturation, there was a 0.79% point increase in venous oxyhaemoglobin saturation. In this model, no other predictors were significant, including superior caval pressure and case-control assignment.
Cerebral autoregulation appears to remain intact despite acute imposition of cerebral venous hypertension following superior cavopulmonary anastomosis. Following superior cavopulmonary anastomosis, cerebral venous oxyhaemoglobin saturation is primarily determined by arterial oxyhaemoglobin saturation.</description><identifier>ISSN: 1047-9511</identifier><identifier>EISSN: 1467-1107</identifier><identifier>DOI: 10.1017/S1047951120000517</identifier><identifier>PMID: 32172701</identifier><language>eng</language><publisher>England: Cambridge University Press</publisher><subject>Anastomosis ; Blood pressure ; Blood Pressure - physiology ; Cardiovascular diseases ; Catheters ; Cerebrovascular Circulation - physiology ; Child, Preschool ; Confidence intervals ; Coronary artery disease ; Data analysis ; Female ; Follow-Up Studies ; Heart Bypass, Right - methods ; Heart diseases ; Hemoglobin ; Humans ; Hypertension ; Hypoxia ; Ischemia ; Male ; Medical instruments ; Oxygen - blood ; Oxygen Consumption ; Oxygenation ; Patients ; Postoperative period ; Pulmonary Veins - diagnostic imaging ; Pulmonary Veins - surgery ; Regression analysis ; Retrospective Studies ; Saturation ; Tetralogy of Fallot ; Vascular Malformations - blood ; Vascular Malformations - physiopathology ; Vascular Malformations - surgery ; Vena Cava, Superior - diagnostic imaging ; Vena Cava, Superior - surgery</subject><ispartof>Cardiology in the young, 2020-04, Vol.30 (4), p.585-587</ispartof><rights>The Author(s), 2020. Published by Cambridge University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c248t-a9ff848891e8979fab86099ef23d62446a0b7091132cc5422a49c8b7e1f37d243</cites><orcidid>0000-0001-6080-8739</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32172701$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thatte, Nikhil</creatorcontrib><creatorcontrib>Zhou, Lingyu</creatorcontrib><creatorcontrib>Kheir, John N</creatorcontrib><title>Impact of the superior cavopulmonary anastomosis on cerebral oxygenation</title><title>Cardiology in the young</title><addtitle>Cardiol Young</addtitle><description>Patients with univentricular heart disease may undergo a superior cavopulmonary anastomosis, an operative intervention that raises cerebral venous pressure and impedance to cerebral venous return. The ability of infantile cerebral autoregulation to compensate for this is not well understood.
We identified all patients undergoing a superior cavopulmonary anastomosis (cases) and compared metrics of cerebral oxygenation upon admission to the ICU with patients following repair of tetralogy of Fallot or arterial switch operation (controls). The primary endpoint was cerebral venous oxyhaemoglobin saturation measured from an internal jugular venous catheter. Other predictor variables included case-control assignment, age, weight, sex, ischemic times, arterial oxyhaemoglobin saturation, mean arterial blood pressure, and superior caval pressure.
A total of 151 cases and 350 controls were identified. The first post-operative cerebral venous oxyhaemoglobin saturation was significantly lower following superior cavopulmonary anastomosis than in controls (44 ± 12 versus 59 ± 15%, p < 0.001), as was arterial oxyhaemoglobin saturation (81 ± 9 versus 98 ± 5%, p < 0.001). Cerebral venous oxyhaemoglobin saturation correlated poorly with superior caval pressure in both groups. When estimated by linear mixed effects model, arterial oxyhaemoglobin saturation was the primary determinant of central venous oxyhaemoglobin saturation in both groups (β = 0.79, p = 3 × 10-14); for every 1% point increase in arterial oxyhaemoglobin saturation, there was a 0.79% point increase in venous oxyhaemoglobin saturation. In this model, no other predictors were significant, including superior caval pressure and case-control assignment.
Cerebral autoregulation appears to remain intact despite acute imposition of cerebral venous hypertension following superior cavopulmonary anastomosis. Following superior cavopulmonary anastomosis, cerebral venous oxyhaemoglobin saturation is primarily determined by arterial oxyhaemoglobin saturation.</description><subject>Anastomosis</subject><subject>Blood pressure</subject><subject>Blood Pressure - physiology</subject><subject>Cardiovascular diseases</subject><subject>Catheters</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Child, Preschool</subject><subject>Confidence intervals</subject><subject>Coronary artery disease</subject><subject>Data analysis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Bypass, Right - methods</subject><subject>Heart diseases</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypoxia</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Oxygen - blood</subject><subject>Oxygen Consumption</subject><subject>Oxygenation</subject><subject>Patients</subject><subject>Postoperative period</subject><subject>Pulmonary Veins - diagnostic imaging</subject><subject>Pulmonary Veins - surgery</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Saturation</subject><subject>Tetralogy of Fallot</subject><subject>Vascular Malformations - blood</subject><subject>Vascular Malformations - physiopathology</subject><subject>Vascular Malformations - surgery</subject><subject>Vena Cava, Superior - diagnostic imaging</subject><subject>Vena Cava, Superior - surgery</subject><issn>1047-9511</issn><issn>1467-1107</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNplUM9LwzAUDqK4Of0DvEjAc_W9JG2Sowx1A8GDei5plmjH2tSkFfff27HpxXd5D75fvI-QS4QbBJS3LwhC6hyRwTg5yiMyRVHIDBHk8XiPcLbDJ-QspTUAco5wSiacoWQScEoWy6YztqfB0_7D0TR0LtYhUmu-QjdsmtCauKWmNakPTUh1oqGl1kVXRbOh4Xv77lrT16E9JyfebJK7OOwZeXu4f50vsqfnx-X87imzTKg-M9p7JZTS6JSW2ptKFaC184yvCiZEYaCSoBE5szYXjBmhraqkQ8_ligk-I9d73y6Gz8GlvlyHIbZjZMlyKQupCgEjC_csG0NK0fmyi3UzvlIilLvuyn_djZqrg_NQNW71p_gti_8AEjBoow</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Thatte, Nikhil</creator><creator>Zhou, Lingyu</creator><creator>Kheir, John N</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0001-6080-8739</orcidid></search><sort><creationdate>20200401</creationdate><title>Impact of the superior cavopulmonary anastomosis on cerebral oxygenation</title><author>Thatte, Nikhil ; Zhou, Lingyu ; Kheir, John N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c248t-a9ff848891e8979fab86099ef23d62446a0b7091132cc5422a49c8b7e1f37d243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anastomosis</topic><topic>Blood pressure</topic><topic>Blood Pressure - physiology</topic><topic>Cardiovascular diseases</topic><topic>Catheters</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Child, Preschool</topic><topic>Confidence intervals</topic><topic>Coronary artery disease</topic><topic>Data analysis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Bypass, Right - methods</topic><topic>Heart diseases</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypoxia</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Oxygen - blood</topic><topic>Oxygen Consumption</topic><topic>Oxygenation</topic><topic>Patients</topic><topic>Postoperative period</topic><topic>Pulmonary Veins - diagnostic imaging</topic><topic>Pulmonary Veins - surgery</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Saturation</topic><topic>Tetralogy of Fallot</topic><topic>Vascular Malformations - blood</topic><topic>Vascular Malformations - physiopathology</topic><topic>Vascular Malformations - surgery</topic><topic>Vena Cava, Superior - diagnostic imaging</topic><topic>Vena Cava, Superior - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thatte, Nikhil</creatorcontrib><creatorcontrib>Zhou, Lingyu</creatorcontrib><creatorcontrib>Kheir, John N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Cardiology in the young</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thatte, Nikhil</au><au>Zhou, Lingyu</au><au>Kheir, John N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the superior cavopulmonary anastomosis on cerebral oxygenation</atitle><jtitle>Cardiology in the young</jtitle><addtitle>Cardiol Young</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>30</volume><issue>4</issue><spage>585</spage><epage>587</epage><pages>585-587</pages><issn>1047-9511</issn><eissn>1467-1107</eissn><abstract>Patients with univentricular heart disease may undergo a superior cavopulmonary anastomosis, an operative intervention that raises cerebral venous pressure and impedance to cerebral venous return. The ability of infantile cerebral autoregulation to compensate for this is not well understood.
We identified all patients undergoing a superior cavopulmonary anastomosis (cases) and compared metrics of cerebral oxygenation upon admission to the ICU with patients following repair of tetralogy of Fallot or arterial switch operation (controls). The primary endpoint was cerebral venous oxyhaemoglobin saturation measured from an internal jugular venous catheter. Other predictor variables included case-control assignment, age, weight, sex, ischemic times, arterial oxyhaemoglobin saturation, mean arterial blood pressure, and superior caval pressure.
A total of 151 cases and 350 controls were identified. The first post-operative cerebral venous oxyhaemoglobin saturation was significantly lower following superior cavopulmonary anastomosis than in controls (44 ± 12 versus 59 ± 15%, p < 0.001), as was arterial oxyhaemoglobin saturation (81 ± 9 versus 98 ± 5%, p < 0.001). Cerebral venous oxyhaemoglobin saturation correlated poorly with superior caval pressure in both groups. When estimated by linear mixed effects model, arterial oxyhaemoglobin saturation was the primary determinant of central venous oxyhaemoglobin saturation in both groups (β = 0.79, p = 3 × 10-14); for every 1% point increase in arterial oxyhaemoglobin saturation, there was a 0.79% point increase in venous oxyhaemoglobin saturation. In this model, no other predictors were significant, including superior caval pressure and case-control assignment.
Cerebral autoregulation appears to remain intact despite acute imposition of cerebral venous hypertension following superior cavopulmonary anastomosis. Following superior cavopulmonary anastomosis, cerebral venous oxyhaemoglobin saturation is primarily determined by arterial oxyhaemoglobin saturation.</abstract><cop>England</cop><pub>Cambridge University Press</pub><pmid>32172701</pmid><doi>10.1017/S1047951120000517</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0001-6080-8739</orcidid></addata></record> |
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| ispartof | Cardiology in the young, 2020-04, Vol.30 (4), p.585-587 |
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| subjects | Anastomosis Blood pressure Blood Pressure - physiology Cardiovascular diseases Catheters Cerebrovascular Circulation - physiology Child, Preschool Confidence intervals Coronary artery disease Data analysis Female Follow-Up Studies Heart Bypass, Right - methods Heart diseases Hemoglobin Humans Hypertension Hypoxia Ischemia Male Medical instruments Oxygen - blood Oxygen Consumption Oxygenation Patients Postoperative period Pulmonary Veins - diagnostic imaging Pulmonary Veins - surgery Regression analysis Retrospective Studies Saturation Tetralogy of Fallot Vascular Malformations - blood Vascular Malformations - physiopathology Vascular Malformations - surgery Vena Cava, Superior - diagnostic imaging Vena Cava, Superior - surgery |
| title | Impact of the superior cavopulmonary anastomosis on cerebral oxygenation |
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