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Kathleen N. Fenton
Kimberly Glogowski
Sherrie Fogg
Kim F. Duncan
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Ann Thorac Surg 2007;83:1431-1436
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Cerebral Oxygen Saturation Does Not Normalize Until After Stage 2 Single Ventricle Palliation

Kathleen N. Fenton, MD*, Katherine Lessman, BS, Kimberly Glogowski, CCP, Sherrie Fogg, CCP, Kim F. Duncan, MD

Department of Surgery, Children’s Hospital, Omaha, Nebraska

Accepted for publication October 3, 2006.

* Address correspondence to Dr Fenton, 14805 Maydale Ct, Silver Spring, MD 20905 (Email: kathleennf{at}msn.com).

Background: In an effort to optimize neurologic outcome, cerebral oxygen saturation (ScO 2) is often measured intraoperatively and postoperatively. We hypothesized that ScO 2 would be related to stage of palliation in children with single ventricle congenital heart disease.

Methods: Cerebral oxygen saturation was continuously recorded intraoperatively in 34 infants and children undergoing palliative surgery on cardiopulmonary bypass for single ventricle congenital heart defects and in a control group of 12 neonates with ductus-dependent circulation undergoing complete repair. Saturations were correlated with the patient’s stage and outcome.

Results: Baseline ScO 2 was 61% in single ventricle neonates (group P1, n = 10), 55% in neonates undergoing repair (group R), 42% in infants undergoing stage 2 palliation (group P2, n = 6), and 70% in children undergoing Fontan (group P3, n = 14). Baseline was lowest (41%) in infants undergoing interstage operations (group I, n = 4). After bypass, there was a significant improvement in ScO 2 to 53% in group P2 infants (p = 0.04); there were no significant changes in the other groups. By the end of the operation, there was a significant decrease in ScO 2 to 48% in group P1 (p = 0.001), with other groups unchanged from baseline. There were five perioperative deaths. Cerebral oxygen saturation at the conclusion of surgery was lower in children who died (38% versus 61%, p = 0.01).

Conclusions: In children with single ventricle physiology, ScO 2 decreases after initial palliation, remains low before second-stage palliation, but is normal before and after the Fontan. This has implications for perioperative mortality, neurologic injury, and potentially for interim mortality. Low postoperative ScO 2 predicts perioperative mortality.


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Invited commentary
Ralph Delius
Ann. Thorac. Surg. 2007 83: 1436-1437. [Extract] [Full Text] [PDF]



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R. Delius
Invited commentary
Ann. Thorac. Surg., April 1, 2007; 83(4): 1436 - 1437.
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