Cerebral autoregulation monitoring in neonates and infants after cardiac surgery with cardiopulmonary bypass - comparison of single ventricle and biventricular physiology

Marcel Methner; Bernadett Schwaneberg; Berit Wikidal; Simon Schmid; Julian Zipfel; Maximilian Iller; Martin U Schuhmann; Yordan H Georgiev; Harry Magunia; Rafal Berger; Christian Schlensak; Johannes Nordmeyer; Felix Neunhoeffer

doi:10.3389/fped.2025.1540870

Cerebral autoregulation monitoring in neonates and infants after cardiac surgery with cardiopulmonary bypass - comparison of single ventricle and biventricular physiology

Front Pediatr. 2025 Mar 28:13:1540870. doi: 10.3389/fped.2025.1540870. eCollection 2025.

Affiliations

¹ Department of Paediatric Cardiology, Pulmology and Paediatric Intensive Care Medicine, University Children's Hospital of Tuebingen, Tuebingen, Germany.
² Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.
³ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany.
⁴ Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.

Abstract

Introduction: Cardiopulmonary bypass surgery can lead to impaired cerebral autoregulation with the risk for ischemia, hemorrhage and delirium. In particular, infants with single ventricle physiology have altered hemodynamics with persistent veno-arterial shunting, cyanosis and diastolic run-off after surgery, which may have negative effects on cerebral autoregulation.

Methods: Cerebral autoregulation was prospectively monitored in 83 neonates and infants after open heart surgery with cardiopulmonary bypass after admission to the pediatric intensive care unit. Autoregulation indices were determined using near-infrared spectroscopy, correlating regional cortical oxygen saturation and local hemoglobin levels with invasive mean arterial pressure. Intact autoregulation was defined as cerebral oxygenation index (COx) < 0.4 and hemoglobin volume index (HVx) < 0.3. A subgroup analysis was performed between 55 infants after biventricular repair surgery and 15 infants after palliative surgery.

Results: The mean lower limit of autoregulation was 46 ± 6 mmHg (COx) and 46 ± 7 mmHg (HVx). The optimal mean arterial pressure according to cerebral autoregulation was 56 ± 8 mmHg (COx) and 55 ± 7 mmHg (HVx). The mean upper limit was 65 ± 9 mmHg (COx) and 65 ± 8 mmHg (HVx). Intact autoregulation occurred during 84 ± 8% (COx) and 77 ± 10% (HVx) of the monitored time. No significant differences were found in autoregulation parameters between single ventricle and biventricular groups. However, the single ventricle group had significantly lower arterial and cerebral oxygen saturation.

Discussion: A standardized blood pressure management may not be sufficient in children after cardiac surgery due to potentially impaired cerebral autoregulation. Therefore, cerebral autoregulation monitoring should be considered in this patient population.

Keywords: cardiac surgery; cardiopulmonary bypass; cerebral autoregulation; congenital heart disease; critical care; near-infrared spectroscopy.

Grants and funding

The author(s) declare that financial support was received for the research and/or publication of this article. Medtronic provides to Research Center up to 80 INVOS^TM Cerebral/Somatic Oxymetry Sensors free of charge for the purpose of the Research. We acknowledge support by Open Access Publishing Fund of University of Tuebingen.