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J Thorac Cardiovasc Surg 1996;112:1073-1080
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS,
MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

CEREBRAL PROTECTION DURING MODERATE HYPOTHERMIC CIRCULATORY ARREST: HISTOPATHOLOGY AND MAGNETIC RESONANCE SPECTROSCOPY OF BRAIN ENERGETICS AND INTRACELLULAR pH IN PIGS

Carlos L. Filgueiras, MD, MSc, PhDab, Lawrence Ryner, PhDa, Jian Ye, MD, MSca, Luojia Yang, MDa, Mauricio Ede, MDa, Jiankang Sun, MSca, Piotr Kozlowski, PhDa, Randy Summers, MSca, John K. Saunders, PhDa, Tomas A. Salerno, MD, MScc, Roxanne Deslauriers, PhDa

Supported by the National Research Council of Canada, and the Heart and Stroke Foundation of Manitoba.

Received for publication Jan. 22, 1996 Revisions requested March 1, 1996; revisions received March 22, 1996 Accepted for publication March 26, 1996. Address for reprints: Roxanne Deslauriers, PhD, Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Ave., Winnipeg, Manitoba, Canada, R3B 1Y6.

Abstract

Objective:We evaluated the effect of antegrade and retrograde brain perfusion during moderate hypothermic circulatory arrest at 28º C. Methods:Phosphorus 31–magnetic resonance spectroscopy was used to follow brain energy metabolites and intracellular pH in pigs during 2 hours of ischemia and 1 hour of reperfusion. Histopathologic analysis of brain tissue fixed at the end of the experimental protocol was performed. Fourteen pigs were divided into two experimental groups subjected to antegrade (n= 6) or retrograde (n= 8) brain perfusion. Anesthesia (n= 8) and hypothermic cardiopulmonary bypass groups (15º C, n= 8) served as control subjects. In the antegrade and retrograde brain perfusion groups, the initial bypass flow rate was 60 to 100 ml · kg-1· min-1. In the antegrade group, the brain was perfused through the carotid arteries at a flow rate of 180 to 210 ml · min-1during circulatory arrest at 28º C. In the retrograde group, the brain was perfused through the superior vena cava at a flow rate of 300 to 500 ml · min-1during circulatory arrest at 28º C. Results:The intracellular pH was 7.1 ± 0.1 and 7.2 ± 0.1 in the anesthesia and hypothermic bypass groups, respectively. Brain intracellular pH and high-energy metabolites (adenosine triphosphate, phosphocreatine) did not change during the course of the 3.5-hour study. In the antegrade group, adenosine triphosphate and intracellular pH were unchanged throughout the protocol. In the retrograde perfusion group, the intracellular pH level decreased to 6.4 ± 0.1, and adenosine triphosphate and phosphocreatine levels decreased within the first 30 minutes of circulatory arrest and remained at low levels until the end of reperfusion. High-energy phosphates did not return to their initial levels during reperfusion. Histopathologic analysis of nine regions of the brain showed good preservation of cell structure in the anesthesia, hypothermic bypass, and antegrade perfusion groups. The retrograde perfusion group showed changes in all the regions examined. Conclusions:The study shows that moderate hypothermic circulatory arrest at 28º C with antegrade brain perfusion during circulatory arrest protects the brain but that retrograde cerebral perfusion at 28º C does not protect the brain. (J THORACCARDIOVASCSURG1996;112:1073-80)




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