Non-invasive cerebral autoregulation monitoring during paediatric cardiac surgery without cardiopulmonary bypass requiring intraoperative cross-clamping of one of the carotid arteries.

Introduction: Neurologic complications remain one of the major risks after pediatric cardiac surgery. Cerebral autoregulation (CA) is a physiologic mechanism regulating cerebral perfusion. A dynamic intraoperative evaluation can possibly detect the impairment of the cerebral regulatory function during surgery. The aim of the present study was to evaluate the utility of dynamic cerebral blood perfusion monitoring using cerebral oxygenation index (COx) as CA parameter during pediatric cardiac surgery without cardiopulmonary bypass (CPB) requiring intraoperative cross-clamping of one carotid artery to perform the procedure.

Materials and methods: Prospective intraoperative autoregulation monitoring was performed in 14 children under the age of 1 year requiring elective cardiac surgery with intraoperative cross-clamping of one of carotid artery. Procedures requiring the use of CPB and redo surgeries were excluded.

Results: Impaired CA could be measured during 33.8% of cross-clamping time on the ipsilateral side and 30.1% on the contralateral side. The difference in COx was not significant before (p = 0.7), during (p = 0.29) and after cross clamping (p = 0.63), but a significant difference in COx levels throughout the entire cohort was noted individually. The mean ABP during normal (COx <0.4) CA was 61.8 mmHg (95% CI 60.7 - 62.9) and 62.9 mmHg (95% CI 61.9 - 63.9) for cross clamped and opposite side. During impaired (COx >0.4) CA the ABP values were 58.9 mmHg (95% CI 57.7 - 60.1, p < 0.05) and 56 mmHg (95% CI 54.8 - 57.3, p < 0.05) respectively.

Conclusions: A dynamic intraoperative monitoring of CA during pediatric cardiac surgery is possible and allows to confirm the impairment of autoregulation during cross-clamping of one of the carotid arteries.