{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T10:58:12Z","timestamp":1793444292648,"version":"4.5.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The objective of this study was to evaluate mean cerebral blood flow velocity, gaseous microemboli (GME) counts, regional cerebral oxygen saturation (rSO\n                      <jats:sub>2<\/jats:sub>\n                      ), and clinical outcomes using multimodality neuromonitoring in risk-stratified congenital cardiac surgery patients and by cyanotic and acyanotic heart disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 377 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass (CPB) were stratified by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality categories and by classification of cyanotic and acyanotic heart disease. Intraoperative mean cerebral blood flow velocity, GME counts, and rSO\n                      <jats:sub>2<\/jats:sub>\n                      were assessed at multiple time points. Clinical outcomes were compared between patients of each STAT mortality category and cyanotic classification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean cerebral blood flow velocities of STAT Mortality Category 5 patients decreased drastically from baseline values after cross-clamp (down to 56%) and after off-bypass (down to 32%), while rSO\n                      <jats:sub>2<\/jats:sub>\n                      values increased significantly during CPB. Patients in STAT mortality category 5 experienced higher GME counts (1.3- to 4.4-fold greater) compared with patients in all other STAT categories. When compared with acyanotic patients, cyanotic patients experienced significantly lower mean blood flow velocity, significantly greater rSO\n                      <jats:sub>2<\/jats:sub>\n                      during CPB, and greater GME counts than acyanotic patients (1.3-fold greater). Although 29 patients experienced neurological injury confirmed by electroencephalogram and magnetic resonance imaging, instances of injury were not correlated with GME counts among risk-stratified and cyanotic versus acyanotic patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Utilization of intraoperative transcranial Doppler, in addition to near-infrared spectroscopy, may help to identify other parameters for cerebral protection, such as drastically decreased cerebral blood flow velocity and increased cerebral microemboli counts, particularly in STAT Mortality Category 5 and cyanotic patients.<\/jats:p>\n                  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