Cerebral Oximetry Monitoring in Patients Undergoing Surgery for Stanford Type A Aortic Dissection.

Objectives: The aim of this study was to evaluate the prognostic impact of cerebral regional oxygen saturation (crSO ₂ ) in patients undergoing surgery for Stanford type A aortic dissection (TAAD).
Design: Observational, retrospective, institutional study.
Setting: University hospital.
Participants: A total of 152 patients who underwent surgery for TAAD from June 2009 to December 2018 at the authors' institution.
Interventions: Surgery for TAAD using continuous perioperative monitoring of crSO ₂ with near-infrared cerebral oximetry (INVOS, Medtronic, MN).
Measurements and Results: The rates of postoperative stroke/global brain ischemia were 22.4% and of hospital mortality 14.5%. Age, hemoglobin, and cardiogenic shock were independent predictors of nadir crSO ₂ from both frontal areas at arrival to the operating room. Repeated measures test showed that changes in crSO ₂ between the first measurement at operating room arrival, at the start of surgery, and at the end of surgery were not significant when measured on the right frontal area (p = 0.632), left frontal area (p = 0.608), as a nadir value from both frontal areas (p = 0.690), and as a difference between frontal areas (p = 0.826) in patients with and without major neurologic complications. Patients who had a nadir crSO ₂ <40% anytime during the perioperative period, had a numerically higher rate of major neurologic complications (27.3% v 20.4%, p = 0.354), but this difference did not reach statistical significance. The incidence of nadir of crSO ₂ value <40% at operating room arrival (5.9%, p = 1.000), at the start of surgery (5.3%, p = 0.685), and at the end of surgery (1.3%, p = 1.000) was rather low and not associated with these adverse events.
Conclusions: Derangements in crSO ₂ detected by cerebral oximetry before and during surgery for TAAD did not predict postoperative stroke and/or global brain ischemia.
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