Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery

Background: The current study was designed to determine the relation between preoperative cerebral oxygen saturation (ScO2), variables of cardiopulmonary function, mortality, and morbidity in a heterogeneous cohort of cardiac surgery patients. Methods: In this study, 1,178 consecutive patients scheduled for on-pump surgery were prospectively studied. Preoperative ScO2, demographics, N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T, clinical outcomes, and 30-day and 1-yr mortality were recorded. Results: Median additive EuroSCORE was 5 (range: 0-19). Thirty-day and 1-yr mortality and major morbidity (at least two major complications and/or a high-dependency unit stay of at least 10 days) were 3.5%, 7.7%, and 13.3%, respectively. Median minimal preoperative oxygen supplemented ScO2 (ScO2min-ox) was 64% (range: 15-92%). ScO2min-ox was correlated (all: P value < 0.0001) with N-terminal pro-B-type natriuretic peptide (rho : - 0.35), high-sensitive troponin T (rho : - 0.28), hematocrit (rho : 0.34), glomerular filtration rate (rho : 0.19), EuroSCORE (tau : 0.20), and left ventricular ejection fraction class (rho : 0.12). Thirty-day nonsurvivors had a lower ScO2min-ox than survivors (median 58% [95% CI, 50.7-62%] vs. 64% [95% CI, 64-65%]; P < 0.0001). Receiver-operating curve analysis of ScO2min-ox and 30-day mortality revealed an area-under-the-curve of 0.71 (95% CI, 0.68-0.73%; P < 0.0001) in the total cohort and an area-under-the-curve of 0.77 (95% CI, 0.69-0.86%; P < 0.0001) in patients with a EuroSCORE more than 10. Logistic regression based on different EuroSCORE categories (0-2; 3-5, 6-10, > 10), ScO2min-ox, and duration of cardiopulmonary bypass showed that a ScO2min-ox equal or less than 50% is an independent risk factor for 30-day and 1-yr mortality. Conclusions: Preoperative ScO2 levels are reflective of the severity of cardiopulmonary dysfunction, associated with short- and long-term mortality and morbidity, and may add to preoperative risk stratification in patients undergoing cardiac surgery.