Immediate Postoperative Evolution of Cerebral Doppler and Saturation Parameters After Cardiopulmonary Bypass in Infants With Congenital Heart Disease: A Prospective Cohort Study

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Abstract
OBJECTIVES: To describe temporal trends and instantaneous relationships between middle cerebral artery (MCA) cerebral blood flow velocity, cerebral oxygen saturation (Csat), cerebral fractional tissue oxygen extraction (cFTOE), and systemic arteriovenous oxygen difference (AV o 2 ) during the first 24 hours following congenital heart disease (CHD) surgery requiring cardiopulmonary bypass (CPB). DESIGN: Prospective observational study conducted from August 2021 to June 2022. SETTING: Single-center pediatric cardiac ICU in Canada. PATIENTS: Fifteen ventilated neonates and infants admitted to the PICU following CHD surgery requiring CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Bilateral transcranial Doppler (TCD) assessments of the MCA were performed at seven predefined time points during the first 24 hours following CPB, with time 0 defined as the end of CPB. A total of 87 simultaneous measurements of systemic oxygen saturation, Csat, TCD-derived parameters, and AV o 2 were analyzed. The nadir in MCA velocities occurred at a mean of 9.3 hours ( sd , 1.7 hr) post-CPB and coincided with the lowest Csat and the highest AV o 2 difference and cFTOE. Lower MCA mean velocities were associated with higher AV o 2 difference and increased cFTOE. CONCLUSIONS: In neonates and infants following CPB, MCA velocities reach its lowest point approximately 9 hours post-CPB, coinciding with the highest AV o 2 difference and previously published nadir of cardiac output. These findings could suggest a period of relative cerebral hypoperfusion. Future studies should evaluate whether targeted interventions guided by multimodal cerebral monitoring can mitigate the risk of acute and long-term brain injury in this vulnerable population.

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