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J Thorac Cardiovasc Surg 2001;122:331-338
© 2001 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology (CPS) |
From the Departments of Cardiothoracic Surgerya and Biomathematics,b Mount Sinai School of Medicine, New York, NY.
This work was supported by grant HL 45636 from the National Institutes of Health and by the Nat Lapkin Foundation.
Received for publication Nov 30, 2000. Revisions requested Jan 26, 2001; revisions received Feb 12, 2001. Accepted for publication Feb 19, 2001. Address for reprints: Randall B. Griepp, MD, Department of Cardiothoracic Surgery, Mount Sinai Medical Center, One Gustave Levy Place, Box 1028, New York, NY 10029.
Abstract
Objectives: Although retrograde cerebral perfusion is being used clinically during aortic arch surgery, whether retrograde flow perfuses the brain effectively is still uncertain.
Methods: Fourteen pigs were cooled to 20°C with cardiopulmonary bypass and perfused retrogradely via the superior vena cava for 30 minutes: 7 underwent standard retrograde cerebral perfusion and 7 underwent retrograde perfusion with occlusion of the inferior vena cava. Antegrade and retrograde cerebral blood flow were calculated by quantitating fluorescent microspheres trapped in brain tissue after the animals were put to death; microspheres returning to the aortic arch, the inferior vena cava, and the descending aorta were also analyzed during retrograde cerebral perfusion.
Results: Antegrade cerebral blood flow was 16 ± 7.7 mL · min–1 · 100 g–1 before retrograde cerebral perfusion and 22 ± 6.3 mL · min–1 · 100 g–1 before perfusion with caval occlusion (P = .14). During retrograde perfusion, calculations based on the number of microspheres trapped in the brain showed negligible flows (0.02 ± 0.02 mL · min–1 · 100 g–1 with retrograde cerebral perfusion and 0.04 ± 0.02 mL · min–1 · 100 g–1 with perfusion with caval occlusion; P = .09): only 0.01% and 0.02% of superior vena caval inflow, respectively. Less than 13% of retrograde superior vena caval inflow blood returned to the aortic arch with either technique. During retrograde cerebral perfusion, more than 90% of superior vena caval input was shunted to the inferior vena cava and was then recirculated, as indicated by rapid development of an equilibrium in microspheres between the superior and inferior venae cavae. With retrograde perfusion and inferior vena caval occlusion, less than 12% of inflow returned to the descending aorta and only 0.01% of microspheres.
Conclusions: The paucity of microspheres trapped within the brain indicates that retrograde cerebral perfusion, either alone or combined with inferior vena caval occlusion, does not provide sufficient cerebral capillary perfusion to confer any metabolic benefit. The slightly improved outcome previously reported with retrograde cerebral perfusion during prolonged circulatory arrest in this model may be a consequence of enhanced cooling resulting from perfusion of nonbrain capillaries and from venoarterial and venovenous shunting.
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