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J Thorac Cardiovasc Surg 1994;108:446-454
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Experimental study of cerebral autoregulation during cardiopulmonary bypass with or without pulsatile perfusion

Sendai, Japan

From the Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.

Presented in part at the Thirty-ninth Congress of the European Society for Cardiovascular Surgery, Budapest, Hungary, Sept. 9-12, 1990.

Received for publication July 30, 1993. Accepted for publication Feb. 22, 1994. Address for reprints: Mitsuaki Sadahiro, MD, Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, 1-1 Seiryocho, Aobaku, Sendai, 980, Japan.

Abstract

Twenty-four adult mongrel dogs were divided into four equal groups according to the following method of cardiopulmonary bypass: normothermic continuous (so-called nonpulsatile) perfusion, normothermic pulsatile perfusion, hypothermic continuous perfusion, and hypothermic pulsatile perfusion. Cerebral blood flow was determined by measuring the volume of sagittal sinus venous blood outflow with a transit-time ultrasonic flowmeter. Cardiopulmonary bypass was initiated at a flow rate of 80 ml/kg per minute. Cerebral temperature was maintained at 37º C per minute. Cerebral temperature was maintained at 37º C in the normothermic groups at 25º C in the hypothermic groups. Aterial pH and carbon dioxide were maintained within the physiologic range by alpha-stat acid-base regulation. Mean cerebral perfusion pressure and blood flow were not affected during the 90 minutes of the bypass. The respective values were 67.1 mm Hg and 37.1 ml/100 gm brain per minute with normothermic continuous perfusion, 72.8 mm Hg and 39.0 ml/100 gm per minute with nonpulsatile perfusion, 98.0 mm Hg and 23.0 ml/100 gm per minute with hypotermic pulsatile perfusion. Pump flow rates were altered from 10 to 120 ml/kg per minute in a stepwise fashion to obtain graded changes of perfusion pressure. Cerebral blood fow, however, was not changed significantly by cerebral perfusion pressure so long as perfusion pressure was greater than 50 mm Hg. Conversely, cerebral blood flow changed proportionally with cerebral perfusion pressure at a pressure less than 50 mm Hg. The correlation between cerebral blood flow and perfusion pressure was described as two separate line determined by linear regression. The slope of regression lines relating cerebral blood flow to perfusion was 0.16 ± 0.08 for cerebral perfusion pressure above 50 mm Hg and 0.68 ± 0.11 below 50 mm Hg in the normothermic continuous person group; 0.14 ± 0.09 and 0.32 ± 0.09 with normothermic pulsatile perfusion; 0.10 ± 0.04 and 0.62 ± 0.18 with hypothermic continuous perfusion; 0.09 ± 0.08 and 0.39 ± 0.04 in the hypothermic pulsatile perfusion group. The slope above 50 mm Hg was significantly smaller and closer to zero in all groups than it was at a perfusion pressure below 50 mm Hg (p < 0.05). The slope and cerebral blood flow for a perfusion pressure above 50 mm Hg was significantly (p < 0.05) smaller and higher, respectively, These data suggest that cerebral autoregulation is intact at cerebral perfusion pressure greater than 50 mm Hg during either normothermic or hypothermic cardiopulmonary bypass, In addition, compared to continuous (nonpulsatile) perfusion, pulsatile bypass generated a higher cerebral blood flow at a cerebral perfusion pressure less than 50 mm Hg. (J THORAC CARDIOVASC SURG 1994;108:446-54)

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