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J Thorac Cardiovasc Surg 1995;110:55-62
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

A ³¹P-magnetic resonance study of antegrade and retrograde cerebral perfusion during aortic arch surgery in pigs

Winnipeg, Manitoba, and Toronto, Ontario, Canada

Supported by the National Research Council Canada and the Heart and Stroke Foundation of Ontario (grant A 2427).

Received for publication June 2, 1994. Accepted for publication Oct. 10, 1994. Address for reprints: Roxanne Deslauriers, PhD, Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Ave., Winnipeg, Manitoba, Canada, R3B 1Y6.

Abstract

To evaluate the effect of hypothermic circulatory arrest on brain metabolism, we used ³¹P-magnetic resonance spectroscopy to monitor brain metabolites in pigs during 2 hours of ischemia and 1 hour of reperfusion. Twenty-eight pigs were divided into five groups. Anesthesia (n = 5) and hypothermic cardiopulmonary bypass groups (n = 5) served as controls. In the circulatory arrest (n = 6), antegrade perfusion (n = 6), and retrograde (n = 6) brain perfusion groups, the bypass flow rate was 60 to 100 mlxkg^-1xmin^-1. In the antegrade group, the brain was perfused via the carotid arteries at a blood flow rate of 180 to 200 mlxmin^-1during circulatory arrest at 15º C. In the retrograde group, the brain was perfused through the superior vena cava at a flow rate of 300 to 500 mlxmin^-1during circulatory arrest at 15º C. The intracellular pH was 7.1±0.1 and 7.3±0.1 in the anesthesia and hypothermic cardiopulmonary bypass groups, respectively. In the circulatory arrest group, the intracellular pH decreased to 6.2±0.1 and did not recover to its initial value (7.0±0.1) during reperfusion (p < 0.05 compared with the value obtained from the control groups at the corresponding time). Inorganic phosphate did not return to its initial level during reperfusion. In three animals in this group, levels of high-energy phosphates, adenosine triphosphate and phosphocreatine, recovered partially but did not reach the levels observed before arrest. In the group receiving antegrade perfusion, cerebral metabolites and intracellular pH were unchanged throughout the protocol. During circulatory arrest in the retrograde perfusion group the intracellular pH decreased to 6.4±0.1 and recovered fully during reperfusion (7.1±0.1). High-energy phosphates also returned to their initial levels during reperfusion. These studies show that deep hypothermic circulatory arrest with antegrade brain perfusion provides the best brain protection of the options investigated. (J THORACCARDIOVASCSURG1995;110:55-62)

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