| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 1999;118:1068-1077
© 1999 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Brain Research Laboratory, Joseph Stokes Research Institute, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia,a and the Department of Anesthesia and Pediatrics,b Department of Pediatrics,c Department of Pathology,d and Department of Neurosurgery,e University of Pennsylvania School of Medicine, Philadelphia, Pa.
Address for reprints: C. Dean Kurth, MD, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, 34th St & Civic Center Blvd, Philadelphia, PA 19104 (E-mail: kurth{at}email.chop.edu).
Objectives: Deep hypothermic circulatory arrest (DHCA) widely used during neonatal heart surgery, carries a risk of brain damage. In adult normothermic ischemia, brain cells in certain regions die, some by necrosis and others by apoptosis (programmed cell death). This study characterized regional brain cell death after DHCA in newborn pigs.
Methods: Eighteen piglets underwent 90 minutes of DHCA and survived 6 hours, 2 days, or 1 week. Six piglets underwent surgery alone or deep hypothermic cardiopulmonary bypass and survived 2 days. Three piglets received no intervention (control). Brain injury was assessed by neurologic and histologic examination and correlated with perioperative factors. Apoptosis and necrosis were identified by light microscopic analysis of cell structure and in situ DNA fragmentation (TUNEL).
Results: All groups subjected to DHCA had brain injury by neurologic and histologic examination, whereas the other groups did not. DHCA damaged neurons in the neocortex and hippocampus and occasionally in the striatum and cerebellum. Damaged neurons in the neocortex were mainly apoptotic and in the hippocampus, a mixture of necrotic and apoptotic neurons. Apoptosis and necrosis were apparent in all DHCA groups even though neurologic deficits improved over the week’s survival. Neocortical and hippocampal damage correlated with blood glucose, hematocrit, and arterial PO2 during and after cardiopulmonary bypass.
Conclusions: In neonates, neocortical and hippocampal neurons are selectively vulnerable to death after DHCA. Both apoptosis and necrosis contribute to neuronal death, beginning early in reperfusion and continuing for days. These data suggest the need for several neuroprotective strategies tailored to the region and death process, initiated during the operation and continued after the operation.
This article has been cited by other articles:
|
|
 |
|
  Y. Iwata, T. Okamura, N. Ishibashi, D. Zurakowski, H. G.W. Lidov, and R. A. Jonas Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1521 - 1529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Pan, L. Sun, W. Ma, Y. Tang, C. Long, L. Tian, N. Liu, Z. Feng, and J. Zheng Overactivation of poly(adenosine phosphate-ribose) polymerase 1 and molecular events in neuronal injury after deep hypothermic circulatory arrest: study in a rabbit model. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1227 - 1233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. G. Ananiadou, K. Bibou, G. E. Drossos, A. Charchanti, M. Bai, S. Haj-Yahia, C. E. Anagnostopoulos, and E. O. Johnson Effect of profound hypothermia during circulatory arrest on neurologic injury and apoptotic repressor protein Bcl-2 expression in an acute porcine model J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 919 - 926. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Sheikh, C. Barrett, N. Villamizar, O. Alzate, S. Miller, J. Shelburne, A. Lodge, J. Lawson, and J. Jaggers Proteomics of cerebral injury in a neonatal model of cardiopulmonary bypass with deep hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 820 - 828. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Schultz, D. Antoni, G. Shears, S. Markowitz, P. Pastuszko, W. Greeley, D. F. Wilson, and A. Pastuszko Brain oxygen and metabolism during circulatory arrest with intermittent brief periods of low-flow cardiopulmonary bypass in newborn piglets J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 839 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 X. Wu, T. Drabek, P. M. Kochanek, J. Henchir, S. W. Stezoski, J. Stezoski, K. Cochran, R. Garman, and S. A. Tisherman Induction of Profound Hypothermia for Emergency Preservation and Resuscitation Allows Intact Survival After Cardiac Arrest Resulting From Prolonged Lethal Hemorrhage and Trauma in Dogs Circulation, April 25, 2006; 113(16): 1974 - 1982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Jungwirth, G. B. Mackensen, M. Blobner, F. Neff, B. Reichart, E. F. Kochs, and G. Nollert Neurologic outcome after cardiopulmonary bypass with deep hypothermic circulatory arrest in rats: Description of a new model J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 805 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Antegrade cerebral perfusion reduces apoptotic neuronal injury in a neonatal piglet model of cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 659 - 665.
|
|
|
|
 |
|
 J. M. Schultz, T. Karamlou, I. Shen, and R. M. Ungerleider Cardiac Output Augmentation During Hypoxemia Improves Cerebral Metabolism After Hypothermic Cardiopulmonary Bypass Ann. Thorac. Surg., February 1, 2006; 81(2): 625 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Schears, T. Zaitseva, S. Schultz, W. Greeley, D. Antoni, D. F. Wilson, and A. Pastuszko Brain oxygenation and metabolism during selective cerebral perfusion in neonates Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 168 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. G. Ananiadou, G. E. Drossos, K. N. Bibou, G. M. Palatianos, and E. O. Johnson Acute regional neuronal injury following hypothermic circulatory arrest in a porcine model Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 597 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Amir, C. Ramamoorthy, R. K. Riemer, V. M. Reddy, and F. L. Hanley Neonatal Brain Protection and Deep Hypothermic Circulatory Arrest: Pathophysiology of Ischemic Neuronal Injury and Protective Strategies Ann. Thorac. Surg., November 1, 2005; 80(5): 1955 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Schubert, G. Stoltenburg-Didinger, A. Wehsack, D. Troitzsch, W. Boettcher, M. Huebler, M. Redlin, M. Kanaan, M. Meissler, P. E. Lange, et al. Large-Dose Pretreatment with Methylprednisolone Fails to Attenuate Neuronal Injury After Deep Hypothermic Circulatory Arrest in a Neonatal Piglet Model Anesth. Analg., November 1, 2005; 101(5): 1311 - 1318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Kerendi, M. E. Halkos, H. Kin, J. S. Corvera, D. J. Brat, M. B. Wagner, J. Vinten-Johansen, Z.-Q. Zhao, J. M. Forbess, K. R. Kanter, et al. Upregulation of hypoxia inducible factor is associated with attenuation of neuronal injury in neonatal piglets undergoing deep hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1079 - 1079. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Loepke, J. A. Golden, J. C. McCann, and C. D. Kurth Injury Pattern of the Neonatal Brain After Hypothermic Low-Flow Cardiopulmonary Bypass in a Piglet Model Anesth. Analg., August 1, 2005; 101(2): 340 - 348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Zaitseva, G. Schears, S. Schultz, J. Creed, D. Antoni, D. F. Wilson, and A. Pastuszko Circulatory Arrest and Low-Flow Cardiopulmonary Bypass Alter CREB Phosphorylation in Piglet Brain Ann. Thorac. Surg., July 1, 2005; 80(1): 245 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. F. Bruggemans, A. van Boxtel, and H. A. Huysmans INVITED COMMENTARY Ann. Thorac. Surg., April 1, 2005; 79(4): 1314 - 1315. [Full Text] [PDF]
|
|
|
|
|
|
S. S. L. Tsui, J. M. Schultz, I. Shen, and R. M. Ungerleider Postoperative hypoxemia exacerbates potential brain injury after deep hypothermic circulatory arrest Ann. Thorac. Surg., July 1, 2004; 78(1): 188 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Myung, M. Petko, A. R. Judkins, G. Schears, R. F. Ittenbach, R. J. Waibel, and W. M. DeCampli Regional low-flow perfusion improves neurologic outcome compared with deep hypothermic circulatory arrest in neonatal piglets J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1051 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Myung, P. M. Kirshbom, M. Petko, J. A. Golden, A. R. Judkins, R. F. Ittenbach, T. L. Spray, and J. W. Gaynor Modified ultrafiltration may not improve neurologic outcome following deep hypothermic circulatory arrest Eur. J. Cardiothorac. Surg., August 1, 2003; 24(2): 243 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schears, S. E. Schultz, J. Creed, W. J. Greeley, D. F. Wilson, and A. Pastuszko Effect of perfusion flow rate on tissue oxygenation in newborn piglets during cardiopulmonary bypass Ann. Thorac. Surg., February 1, 2003; 75(2): 560 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H H Hovels-Gurich, K Konrad, M Wiesner, R Minkenberg, B Herpertz-Dahlmann, B J Messmer, and G von Bernuth Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries Arch. Dis. Child., December 1, 2002; 87(6): 506 - 510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Sato, D. T. Laskowitz, E. R. Bennett, M. F. Newman, D. S. Warner, and H. P. Grocott Differential Cerebral Gene Expression During Cardiopulmonary Bypass in the Rat: Evidence for Apoptosis? Anesth. Analg., June 1, 2002; 94(6): 1389 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Wong Alkalosis induced by alpha-stat management: Cause of neuronal injury after deep hypothermic circulatory arrest? J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 394 - 395. [Full Text]
|
|
|
|
|
|
C. D. Kurth and M. Priestley Reply J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 395 - 396. [Full Text]
|
|
|
|
|
|
T. Ueno, Y. Sawa, S. Kitagawa-Sakakida, M. Nishimura, R. Morishita, Y. Kaneda, E. Kohmura, T. Yoshimine, and H. Matsuda Nuclear factor-{kappa}B decoy attenuates neuronal damage after global brain ischemia: A future strategy for brain protection during circulatory arrest J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 720 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Kurth, J. L. Steven, L. M. Montenegro, H. M. Watzman, J. W. Gaynor, T. L. Spray, and S. C. Nicolson Cerebral oxygen saturation before congenital heart surgery Ann. Thorac. Surg., July 1, 2001; 72(1): 187 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. A. Tatton, C. Hagl, S. Nandor, S. Insolia, D. Spielvogel, and R. B. Griepp Apoptotic cell death in the hippocampus due to prolonged hypothermic circulatory arrest: comparison of cyclosporine A and cycloheximide on neuron survival Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 746 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, N. A. Tatton, D. J. Weisz, N. Zhang, D. Spielvogel, H. H. Shiang, C. A. Bodian, and R. B. Griepp Cyclosporine A as a potential neuroprotective agent: a study of prolonged hypothermic circulatory arrest in a chronic porcine model Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 756 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Ehrlich, J. McCullough, D. Wolfe, N. Zhang, H. Shiang, D. Weisz, C. Bodian, and R. B. Griepp Cerebral effects of cold reperfusion after hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 923 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T.-A. Miyamoto and K.-J. Miyamoto Alkalosis induced by alpha-stat management: Cause of neuronal injury after deep hypothermic perfusion J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 817 - 818. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Priestley, J. A. Golden, I. B. O'Hara, J. McCann, and C. D. Kurth Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0336 - 343. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
