{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T22:49:46Z","timestamp":1780958986195,"version":"3.54.1"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Neurologic complications remain a major cause of morbidity in patients undergoing surgical repair of acute type A aortic dissection (ATAAD). Near-infrared spectroscopy (NIRS) is used for continuous, noninvasive monitoring of cerebral oxygenation during cardiopulmonary bypass; however, its utility in predicting perioperative stroke remains inadequately defined. A retrospective cohort study was conducted in 175 patients who underwent ATAAD repair between 2015 and 2023. Patients were stratified by the occurrence of perioperative stroke (n = 47, 26.9%). Intraoperative NIRS data, including cerebral regional oxygen saturation (crSO2) values at key procedural timepoints and signal variability with band power and crest factor, were analyzed in conjunction with demographic, anatomic, and postoperative variables. Patients with stroke exhibited significantly lower minimum NIRS values during deep hypothermic circulatory arrest (DHCA) (left: 46.7 (15.7\u201369.4) vs. 52.2 (22.0\u201381.6); right: 47.0 (23.3\u201378.5) vs. 56.3 (20.2\u201385.0); p = 0.03 and p &lt; 0.01). Within the stroke group, NIRS signal variability was significantly greater (crest factor and standard deviation; p &lt; 0.05) and showed blunted recovery post-DHCA. crSO2 values below 50% were more frequent in the stroke group (p = 0.04). Right common carotid artery dissection was more prevalent in the stroke group (40% vs. 23%, p = 0.04). ICU length of stay was significantly increased in patients with stroke. Cerebral desaturation and NIRS signal instability during DHCA are significantly associated with perioperative stroke in ATAAD repair. These findings support the prognostic value of intraoperative cerebral oximetry in detecting critical ischemic thresholds and identifying at-risk perfusion patterns.<\/jats:p>","DOI":"10.3390\/life15081295","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T14:51:46Z","timestamp":1755183106000},"page":"1295","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Near-Infrared Spectroscopy Patterns as Indicator of Perioperative Stroke in Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8855-3243","authenticated-orcid":false,"given":"Henrik","family":"Heuer","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9560-4015","authenticated-orcid":false,"given":"Christian","family":"Schach","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Kr\u00e4mer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jozef","family":"Micek","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7903-7890","authenticated-orcid":false,"given":"Franz","family":"Putz","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Fl\u00f6rchinger","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Rohlffs","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany"},{"name":"Department of Occupational Medicine, University Medical Center Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.athoracsur.2024.01.021","article-title":"EACTS\/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ","volume":"118","author":"Czerny","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Raksamani, K., Tangvipattanapong, M., Charoenpithakwong, N., Silarat, S., Pantisawat, N., Sanphasitvong, V., and Raykateeraroj, N. (2024). Postoperative Stroke in Acute Type A Aortic Dissection: Incidence, Outcomes, and Perioperative Risk Factors. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02499-9"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5853\/jos.2024.02915","article-title":"Neurovascular Complications of Acute Aortic Syndrome","volume":"27","author":"Zeldich","year":"2025","journal-title":"J. Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Goco\u0142, R., Hudziak, D., Bis, J., Mendrala, K., Morkisz, \u0141., Podsiad\u0142o, P., Kosi\u0144ski, S., Pi\u0105tek, J., and Darocha, T. (2021). The Role of Deep Hypothermia in Cardiac Surgery. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137061"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1053\/j.jvca.2020.11.035","article-title":"Brain Protection in Aortic Arch Surgery: An Evolving Field","volume":"35","author":"Qu","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/1751143720977280","article-title":"Cerebral Oximetry in Adult Cardiac Surgery to Reduce the Incidence of Neurological Impairment and Hospital Length-of-Stay: A Prospective, Randomized, Controlled Trial","volume":"23","author":"Bennett","year":"2022","journal-title":"J. Intensive Care Soc."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wirayannawat, W., Amawat, J., Yamsiri, N., Paes, B., and Kitsommart, R. (2023). Comparison of the SenSmartTM and the INVOSTM Neonatal Cerebral Near-Infrared Spectrometry Devices. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1243977"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.ejcts.2004.06.014","article-title":"Near-Infrared Spectroscopy for Monitoring Cerebral Ischemia during Selective Cerebral Perfusion","volume":"26","author":"Orihashi","year":"2004","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1053\/j.jvca.2021.09.049","article-title":"Interventions Triggered During Routine Use of NIRS Cerebral Oxygenation Monitoring in Cardiac Surgical Patients","volume":"36","author":"Bochmann","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s10877-024-01241-3","article-title":"Association of Early Perioperative Stroke after Cardiothoracic Surgery with Intraoperative Regional Cerebral Oxygenation Using Near-Infrared Spectroscopy: An Observational Cohort Study Comparing Affected versus Non-Affected Hemispheres","volume":"39","author":"Pierik","year":"2025","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ezad412","DOI":"10.1093\/ejcts\/ezad412","article-title":"Validation of the GERAADA Score to Predict 30-Day Mortality in Acute Type A Aortic Dissection in a Single High-Volume Aortic Centre","volume":"65","author":"Berezowski","year":"2024","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_12","unstructured":"(2025, April 12). Sterbetafel, Bayerisches Landesamt f\u00fcr Statistik, GENESIS-Tabelle: 12621-002, Bayern, Jahr: 2021\/23. Available online: https:\/\/www.lifetable.de\/File\/GetDocument\/data\/DEU\/DEU002020212023CU1.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e193","DOI":"10.1161\/CIR.0000000000000885","article-title":"Considerations for Reduction of Risk of Perioperative Stroke in Adult Patients Undergoing Cardiac and Thoracic Aortic Operations: A Scientific Statement from the American Heart Association","volume":"142","author":"Gaudino","year":"2020","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1053\/j.jvca.2024.09.140","article-title":"Correlation Between Intraoperative Near-Infrared Spectroscopy Values and Neurologic Outcomes in Patients Undergoing Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique","volume":"39","author":"Kletzer","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.athoracsur.2023.09.026","article-title":"Association of Cerebral Oximetry with Brain Ischemic Lesions and Functional Outcomes in Arch Repair","volume":"117","author":"Hibino","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1161\/STROKEAHA.108.514877","article-title":"Continuous Measurement of Autoregulation by Spontaneous Fluctuations in Cerebral Perfusion Pressure: Comparison of 3 Methods","volume":"39","author":"Brady","year":"2008","journal-title":"Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1089\/neu.2010.1388","article-title":"Noninvasive Monitoring of Cerebrovascular Reactivity with near Infrared Spectroscopy in Head-Injured Patients","volume":"27","author":"Zweifel","year":"2010","journal-title":"J. Neurotrauma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.xjon.2022.03.001","article-title":"Surgical Management and Outcomes in Patients with Acute Type A Aortic Dissection and Cerebral Malperfusion","volume":"10","author":"Vendramin","year":"2022","journal-title":"JTCVS Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1161\/CIRCULATIONAHA.118.038099","article-title":"Impact of Carotid Artery Involvement in Type A Aortic Dissection","volume":"139","author":"Kreibich","year":"2019","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/ejcts\/ezaa156","article-title":"Prediction of Mortality Rate in Acute Type A Dissection: The German Registry for Acute Type A Aortic Dissection Score","volume":"58","author":"Czerny","year":"2020","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1213\/01.ane.0000246814.29362.f4","article-title":"Monitoring Brain Oxygen Saturation during Coronary Bypass Surgery: A Randomized, Prospective Study","volume":"104","author":"Murkin","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.athoracsur.2008.08.070","article-title":"Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay after Cardiac Surgery","volume":"87","author":"Slater","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1161\/01.STR.0000236024.68020.3a","article-title":"Watershed Strokes after Cardiac Surgery: Diagnosis, Etiology, and Outcome","volume":"37","author":"Gottesman","year":"2006","journal-title":"Stroke"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sainbhi, A.S., Vakitbilir, N., Gomez, A., Stein, K.Y., Froese, L., and Zeiler, F.A. (2023). Non-Invasive Mapping of Cerebral Autoregulation Using Near-Infrared Spectroscopy: A Study Protocol. 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