Cardiac surgery including cardiopulmonary bypass operation needs maintenance of the cerebral blood flow to prevent postoperative neurological injury, as a reduced cerebral blood flow may result in hazardous changes in the cerebral energy metabolism. State-of-the-art methods for neuromonitoring during such surgery are limited.

An innovative optical neuromonitoring system combining broadband near-infrared spectroscopy for measuring the oxidation state of cytochrome c oxidase, which is a direct marker of cellular energy metabolism, and diffuse correlation spectroscopy to provide an index of cerebral blood flow was translated into a clinical study. Continuous intraoperative monitoring of cerebral perfusion and metabolism could be performed with temporal resolutions sufficient to capture physiological responses to on / off transitions of the cardiopulmonary bypass pump and intraoperative hypoperfusion events.

The presented study shows the feasibility as well as the potential of intraoperative optical monitoring techniques, which are adapted to detect specific signals of important clinical parameters, and can be obtained in a safe and non-invasive manner from the right temporal region of the forehead. Further studies are necessary to identify possible clinical improvements in terms of operative patient management, of its impact on the appearance of postoperative side effects, and finally on the reduction of adverse events. Besides the technical and scientific progress of the described optical monitoring system, a direct comparison to simultaneously performed standard monitoring is needed to underline the clinical importance and impact of this very interesting approach.

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