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Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children

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Abstract

Recently, it is common to perform the Fontan procedure after the Glenn procedure as surgical repair for the univentricular heart. How the brain oxygen saturation (rSO2) values change with the cardiac restoration and the process of growth during these procedures in individual children remains unknown. In this study, we retrospectively studied rSO2 data as well as the perioperative clinical records of 30 children who underwent both Glenn and Fontan procedures by the same surgeon in the same institute. The rSO2 was measured at the beginning and end of each procedure with an INVOS 5100C. Cerebral perfusion pressure was calculated by subtracting central venous pressure from mean arterial pressure. Arterial oxygen saturation (SaO2) and the hemoglobin concentration were obtained as candidates affecting rSO2 changes at the start and the end of both procedures. The rSO2 increased during the Glenn procedure, but this increase was slight and insignificant. On the other hand, the rSO2 significantly increased during the Fontan procedure. Significant increases in SaO2 were observed only between the beginning and end of the Fontan procedure. Correlation coefficients determined by linear regression analysis were more than 0.5 between rSO2 and SaO2 in both procedures. Multiple linear regression analysis showed that SaO2 was the key determinant of the rSO2. The rSO2 increases step by step from the Glenn to the Fontan procedure in the same patient. Within each procedure, SaO2 is the key determinant of the rSO2. The significance of rSO2 monitoring in these procedures should be further evaluated.

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Authors and Affiliations

  1. Department of Anesthesiology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 0608638, Japan

    Yasunori Yagi, Masataka Yamamoto, Hitoshi Saito & Toshihiro Mori

  2. Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine Hokkaido University, N15 W7 Kita-ku, Sapporo, 0608638, Japan

    Yuji Morimoto

  3. Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine Hokkaido University, N15 W7 Kita-ku, Sapporo, 0608638, Japan

    Takayoshi Oyasu & Tsuyoshi Tachibana

  4. Department of Biostatistics, Faculty of Medicine and Graduate School of Medicine Hokkaido University, N15 W7 Kita-ku, Sapporo, 0608638, Japan

    Yoichi M. Ito

Authors
  1. Yasunori Yagi
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  2. Masataka Yamamoto
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  3. Hitoshi Saito
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  4. Toshihiro Mori
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  5. Yuji Morimoto
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  6. Takayoshi Oyasu
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  7. Tsuyoshi Tachibana
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  8. Yoichi M. Ito
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Corresponding author

Correspondence to Yuji Morimoto.

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All authors declare that we have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (015-0466) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

According to our institutional policy, the informed consent is not required in case of retrospective study. Therefore, we did not obtain the individual informed consent. Instead, we open the information of this study through our institutional homepage according to our institutional rule.

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Yagi, Y., Yamamoto, M., Saito, H. et al. Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children. Pediatr Cardiol 38, 1215–1219 (2017). https://doi.org/10.1007/s00246-017-1647-0

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  • DOI: https://doi.org/10.1007/s00246-017-1647-0

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