Open Access

ARTICLE

Effect of Hemodilution on Fluctuation of Cerebral Oxygen Saturation during Cardiopulmonary Bypass in Children with Cyanotic Congenital Heart Disease

Misook Seo¹, In-Kyung Song², Hye-Mee Kwon², Byungdoo Andrew Lee², Won-Jung Shin^2,*

1 Department of Anesthesiology, Damsoyu Hospital, Seoul, Korea
2 Department Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea

* Corresponding Author: Won-Jung Shin. Email:

Congenital Heart Disease 2021, 16(2), 123-136. https://doi.org/10.32604/CHD.2021.012626

Received 08 July 2020; Accepted 28 September 2020; Issue published 26 January 2021

Abstract

Background: In patients with cyanotic congenital heart disease (CHD), cerebral oxygenation may be maintained by elevations in hematocrit (Hct). Hemodilution accompanying cardiopulmonary bypass (CPB), however, can disrupt cerebral oxygen balance, leading to fluctuations in cerebral oxygen saturation (ScO₂). The present study investigated the effects of Hct changes on the fluctuation of ScO₂ during CPB in cyanotic CHD using performance measurement (PM). Methods: Children with CHD (51 acyanotic and 46 cyanotic) who had undergone cardiac surgery using CPB were enrolled. Median performance error (MDPE), median absolute performance error (MDAPE), and wobble parameters of ScO₂ were calculated before (reference value), during, and after CPB. Correlations of PM parameters with Hct and reductions in Hct (ΔHct) were also evaluated. Results: Before CPB, patients with cyanotic CHD had lower MDPE and larger wobble than those with acyanotic CHD, although mean ScO₂ did not differ significantly between the two groups. During CPB, ScO₂ of acyanotic CHD increased as ΔHct increased, but PM variables were not associated with ΔHct. In cyanotic CHD, MDPE (r = −0.324, p = 0.032) and MDAPE (r = 0.339, p = 0.024) correlated significantly with ΔHct during CPB. After CPB, MDPE (r = 0.574, p = 0.025) and MDAPE (r = −0.543, p = 0.036) were significantly correlated with Hct in children with cyanotic CHD who underwent palliative surgery. Conclusion: Therefore, ScO₂ fluctuation during CPB in children with cyanotic CHD may be affected by the decrease in Hct, suggesting that excessive hemodilution can negatively influence the maintenance of cerebral oxygenation in these patients.

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