Brain tissue perfusion during pulmonary endarterectomy - The impact of controlled regional cooling

Abstract

Background

Open pulmonary endarterectomy (PEA) carries a high risk of neurological complications due to cerebral hypoperfusion and ischemia–reperfusion injury. Systemic cooling during extracorporeal circulation may not sufficiently reduce brain temperature. Combining systemic and targeted head–neck cooling may enhance neuroprotection.

Methods

In this single-center retrospective study, 22 PEA patients were analyzed. All underwent deep systemic hypothermia (22–24°C). Eleven received adjunctive external head cooling using the Aurora head–neck device, and eleven used ice packs (Control). Cerebral oxygenation was monitored with near-infrared spectroscopy (NIRS), and neuron-specific enolase (NSE) levels were measured preoperatively and postoperatively.

Results

Cerebral desaturation events (rSO₂ < 40%) occurred in 22.2% of Aurora patients versus 77.8% of Controls (p = 0.030). Postoperative NSE levels were lower in the Aurora group; however, the difference did not reach statistical significance (p = 0.087).

Conclusion

Dual-modality cooling combining extracorporeal hypothermia and targeted head–neck cooling improved intraoperative cerebral oxygenation and were associated with lower postoperative NSE levels; however, due to the limited sample size, no definitive conclusions regarding neuronal injury can be drawn.