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Cited by 77Congenital Heart Disease StudiesCardiac and Coronary Surgery TechniquesCardiovascular Conditions and Treatments

Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery: Cerebral TOI and Neurodevelopmental Outcome

Aly, Safwat A., Zurakowski, David, Glass, Penny, Skurow-Todd, Kami, Jonas, Richard A., Donofrio, Mary T.·2017·Congenital Heart Disease
DOI 10.1111/chd.12426
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Abstract

IMPORTANCE: There are no well-established noninvasive biomarkers for identifying patients at risk for poor outcome after surgery for congenital heart disease. Few studies have assessed prognostic accuracy of cerebral tissue oxygenation index (cTOI) measured by near infrared spectroscopy (NIRS). OBJECTIVE: To assess the utility of noninvasive NIRS monitoring as a predictor of outcomes after neonatal cardiac surgery through measurement of cTOI. To examine the utility of noninvasive NIRS monitoring in combination with lactate concentration and inotropic score in prediction of outcomes after neonatal cardiac surgery. DESIGN: Prospective longitudinal cohort study. SETTING: Operating room and cardiac intensive care unit, Children's National Heart Institute. PARTICIPANTS: Seventy-five patients with complex congenital heart disease undergoing surgical repair within first month of life. EXPOSURE: Cerebral TOI, blood lactate, and inotropic scores were measured preoperative, intraoperative and up to 24 hours postoperative. MAIN OUTCOME MEASURES: Postoperative mortality and neurodevelopmental outcome assessed by the Bayley Scales of Infant Development (BSID II). Mental and motor scores were obtained at 6, 15, and 21 months. Good outcome was defined as survival and BSID mental and motor scores ≥70 points. Poor outcome was defined as death or BSID scores <70 at most recent follow-up. RESULTS: Cohort of 75 patients prospectively followed including 40 patients with single ventricle and 35 with two ventricles. Four patients died before discharge and ten died within 21 months. Seven patients were lost to follow-up. Among survivors with follow-up (n = 54), BSID was abnormal in 25 (46%). Patients with poor outcome (n = 39) had lower mean cTOI 60 minutes off-CPB (48% vs. 58%, P = .003) and 24 hours postoperative (49% vs. 59%, P < .001), higher lactate (8.2 vs. 5.0 mmol/L, P = .005) and higher inotropic scores (10 vs. 6, P = .02) at 24 hours postoperative. ROC analysis indicated that cTOI had moderate predictive accuracy of outcome (AUC = 0.751, P < .001). Multivariable regression analysis confirmed that predictive accuracy was improved using both cTOI and lactate at 24 hours postoperative (AUC = 0.813, 95% CI: 0.705-0.921, P < .001) with optimal cutoff values <58% and >7.4 mmol/L, respectively (sensitivity = 95%). CONCLUSION: Cerebral TOI combined with lactate at 24 hours postoperative are accurate non-invasive predictive biomarkers of patient survival and neurodevelopmental outcome in neonates with CHD undergoing cardiac surgery.

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  • Aly et al. reported that a cerebral oxygen saturation threshold of <58%, when combined with a lactate concentration > 7.4 mmol/L at 24 h post-neonatal cardiac surgery, served as a reliable predictor of survival and neurodevelopmental outcomes.

    “Aly et al. reported that a cerebral oxygen saturation threshold of <58%, when combined with a lactate concentration > 7.4 mmol/L at 24 h post-neonatal cardiac surgery, served as a reliable predictor of survival and neurodevelopmental outcomes [66].”

    From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [66]

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Authors
Aly, S. A., Zurakowski, D., Glass, P., Skurow-Todd, K., Jonas, R. A., & Donofrio, M. T.
Affiliations
  • Children's National (US)
  • Boston Children's Hospital (US)
Corresponding author
Aly, Safwat A.
ORCID
Venue
Congenital Heart Disease
Publisher
Tech Science Press
Published
2016-11-10
Volume
12
Issue
2
Pages
188-195
ISSN
1747-079X (ISSN-L)
DOI
10.1111/chd.12426
OpenAlex
W2556567402
Cited by
77
References
34
Citations by year
2026: 8 · 2025: 7 · 2024: 9 · 2023: 7 · 2022: 15 · 2021: 9 · 2020: 8 · 2019: 9 · 2018: 1 · 2017: 3
FWCI
4.06
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Congenital Heart Disease (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • CreFF Grant from Children's National Medical Center, Washington, DC
  • Saving Tiny Hearts Society
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
Keywords
near-infrared spectroscopy, neonatal cardiac surgery, blood lactate, inotropic score, neurodevelopmental outcomes, postoperative mortality, single ventricle, prognostic factors, cardiopulmonary bypass, Bayley Scales of Infant Development, non-invasive monitoring, outcome prediction model
MeSH terms
Age Factors, Brain, Cerebrovascular Circulation, Child Development, District of Columbia, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Longitudinal Studies, Motor Activity, Nervous System, Oxygen, Oxygen Consumption, Predictive Value of Tests, Prospective Studies, Risk Factors, ROC Curve, Sympathomimetics, Time Factors, Biomarkers, Multivariate Analysis, Logistic Models, Treatment Outcome, Hospital Mortality, Infant Behavior, Spectroscopy, Near-Infrared, Lactic Acid, Area Under Curve

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