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The Journal of Thoracic and Cardiovascular Surgery, Vol 109, Issue 5 948-957, Copyright © 1995 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NOTE: The fulltext of this article is not available online.
T. Hiramatsu, T. Miura, J. M. Forbess, A. Du Plessis, M. Aoki, F. Nomura, D. Holtzman and R. A. Jonas
The pH-stat strategy compared with the alpha-stat strategy provides more
rapid recovery of brain high-energy phosphate stores and intracellular pH
after 1 hour of hypothermic circulatory arrest in pigs. Possible mechanisms
for this difference are (1) improved oxygen delivery and homogeneity of
brain cooling before deep hypothermic circulatory arrest and (2) greater
cerebral blood flow and reduced reperfusion injury owing to extracellular
acidosis during the rewarming phase. To identify which of these mechanisms
is predominant, we studied 49 4-week-old piglets undergoing 1 hour of deep
hypothermic circulatory arrest. Four groups were defined according to
cooling/rewarming strategy: alpha/alpha, alpha/pH, pH/alpha, and pH/pH. In
24 animals cerebral high-energy phosphate levels and intracellular pH were
measured by magnetic resonance spectroscopy (alpha/alpha group 7, alpha/pH
group 5, pH/alpha group 7, pH/pH group 5). In 25 animals cerebral blood
flow was measured by labeled microspheres, cerebral metabolic rate by
oxygen and glucose extraction, and the redox state of cytochrome aa3 and
hemoglobin oxygenation by near infrared spectroscopy (alpha/alpha group 7,
alpha/pH group 5, pH/alpha group 7, pH/pH group 6). Cerebral blood flow was
greater with pH-stat than alpha-stat during cooling (56.3% +/- 3.7% versus
32.9% +/- 2.1% of normothermic baseline values, p < 0.001).
Cytochrome aa3 values became more reduced during cooling with alpha-stat
than with pH-stat (p = 0.049). Recovery of adenosine triphosphate levels in
the initial 45 minutes of reperfusion was more rapid in group pH/pH
compared with that in the other groups (p = 0.029). Recovery of cerebral
intracellular pH in the initial 30 minutes was faster in group pH/pH
compared with that in group alpha/alpha (p = 0.026). Intracellular pH
became more acidic during early reperfusion only in group alpha/alpha,
whereas it showed continuous recovery in the other groups. This study
suggests that there are mechanisms in effect during both the cooling and
rewarming phases before and after deep hypothermic circulatory arrest that
could contribute to an improved cerebral outcome with pH-stat relative to
more alkaline strategies.
JOURNAL ARTICLE
pH strategies and cerebral energetics before and after circulatory arrest
Department of Cardiovascular Surgery, Children's Hospital, Boston, MA 02115, USA.
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