HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marek P. Ehrlich Jock N. McCullough Randall B. Griepp Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ehrlich, M. P. Articles by Griepp, R. B. Search for Related Content PubMed PubMed Citation Articles by Ehrlich, M. P. Articles by Griepp, R. B. Related Collections Cerebral protection Extracorporeal circulation

J Thorac Cardiovasc Surg 2001;122:331-338
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CPS)

Retrograde cerebral perfusion provides negligible flow through brain capillaries in the pig

From the Departments of Cardiothoracic Surgery^a 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.

This article has been cited by other articles:

				T. M. Sundt III, T. A. Orszulak, D. J. Cook, and H. V. Schaff Improving Results of Open Arch Replacement Ann. Thorac. Surg., September 1, 2008; 86(3): 787 - 796. [Abstract] [Full Text] [PDF]

				N. Khaladj, M. Shrestha, S. Meck, S. Peterss, H. Kamiya, K. Kallenbach, M. Winterhalter, L. Hoy, A. Haverich, and C. Hagl Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 908 - 914. [Abstract] [Full Text] [PDF]

				F. Bakhtiary, S. Dogan, A. Zierer, O. Dzemali, F. Oezaslan, P. Therapidis, F. Detho, T. Wittlinger, S. Martens, P. Kleine, et al. Antegrade Cerebral Perfusion for Acute Type A Aortic Dissection in 120 Consecutive Patients Ann. Thorac. Surg., February 1, 2008; 85(2): 465 - 469. [Abstract] [Full Text] [PDF]

				G. D. Touati, P. Marticho, M. Farag, D. Carmi, C. Szymanski, M. Barry, F. Trojette, and T. Caus Totally normothermic aortic arch replacement without circulatory arrest Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 263 - 268. [Abstract] [Full Text] [PDF]

				D. K. Harrington, F. Fragomeni, and R. S. Bonser Cerebral Perfusion Ann. Thorac. Surg., February 1, 2007; 83(2): S799 - S804. [Abstract] [Full Text] [PDF]

				Y. Yang, Z. Li, L. Yang, M. Jackson, A. Turner, and J. Ye Effect of pH Management on Brain Perfusion During Retrograde Cerebral Perfusion Asian Cardiovasc Thorac Ann, December 1, 2006; 14(6): 495 - 500. [Abstract] [Full Text] [PDF]

				M. Kawata, S. Takamoto, K. Kitahori, H. Tsukihara, T. Morota, M. Ono, N. Motomura, A. Murakami, and Y. Suematsu Intermittent pressure augmentation during retrograde cerebral perfusion under moderate hypothermia provides adequate neuroprotection: An experimental study J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 80 - 88. [Abstract] [Full Text] [PDF]

				K. Kitahori, S. Takamoto, H. Takayama, Y. Suematsu, M. Ono, N. Motomura, T. Morota, and K. Takeuchi A novel protocol of retrograde cerebral perfusion with intermittent pressure augmentation for brain protection J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 363 - 370. [Abstract] [Full Text] [PDF]

				D. Spielvogel, J. C. Halstead, M. Meier, I. Kadir, S. L. Lansman, R. Shahani, and R. B. Griepp Aortic Arch Replacement Using a Trifurcated Graft: Simple, Versatile, and Safe Ann. Thorac. Surg., July 1, 2005; 80(1): 90 - 95. [Abstract] [Full Text] [PDF]

				R.S. Bonser and D.K. Harrington Editorial comment Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 102 - 103. [Full Text] [PDF]

				L. G. Svensson, E. H. Blackstone, J. Rajeswaran, J. F. Sabik III, B. W. Lytle, G. Gonzalez-Stawinski, P. Varvitsiotis, M. K. Banbury, P. M. McCarthy, G. B. Pettersson, et al. Does the Arterial Cannulation Site for Circulatory Arrest Influence Stroke Risk? Ann. Thorac. Surg., October 1, 2004; 78(4): 1274 - 1284. [Abstract] [Full Text] [PDF]

				T. Miyairi, S. Takamoto, Y. Kotsuka, A. Takeuchi, K. Yamanaka, and H. Sato Neurocognitive outcome after retrograde cerebral perfusion Ann. Thorac. Surg., May 1, 2004; 77(5): 1630 - 1634. [Abstract] [Full Text] [PDF]

				J. Ye, Z. Li, Y. Yang, L. Yang, A. Turner, M. Jackson, and R. Deslauriers Use of a pH-stat strategy during retrograde cerebral perfusion improves cerebral perfusion and tissue oxygenation Ann. Thorac. Surg., May 1, 2004; 77(5): 1664 - 1670. [Abstract] [Full Text] [PDF]

				C. Hagl, J. D. Galla, D. Spielvogel, C. Bodian, S. L. Lansman, R. Squitieri, M. A. Ergin, and R. B. Griepp Diabetes and evidence of atherosclerosis are major risk factors for adverse outcome after elective thoracic aortic surgery J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1005 - 1012. [Abstract] [Full Text] [PDF]

				A. L. Estrera, Z. Garami, C. C. Miller III, R. Sheinbaum, T. T. T. Huynh, E. E. Porat, A. Winnerkvist, and H. J. Safi Determination of cerebral blood flow dynamics during retrograde cerebral perfusion using power M-mode transcranial Doppler Ann. Thorac. Surg., September 1, 2003; 76(3): 704 - 710. [Abstract] [Full Text] [PDF]

				C. Hagl, N. Khaladj, M. Karck, K. Kallenbach, R. Leyh, M. Winterhalter, and A. Haverich Hypothermic circulatory arrest during ascending and aortic arch surgery: the theoretical impact of different cerebral perfusion techniques and other methods of cerebral protection Eur. J. Cardiothorac. Surg., September 1, 2003; 24(3): 371 - 378. [Abstract] [Full Text] [PDF]

				J. M. Murkin Retrograde cerebral perfusion: more risk than benefit? J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 631 - 633. [Full Text] [PDF]

				L. F. Duebener, I. Hagino, K. Schmitt, T. Sakamoto, C. Stamm, D. Zurakowski, H.-J. Schafers, and R. A. Jonas Direct visualization of minimal cerebral capillary flow during retrograde cerebral perfusion: an intravital fluorescence microscopy study in pigs Ann. Thorac. Surg., April 1, 2003; 75(4): 1288 - 1293. [Abstract] [Full Text] [PDF]

				C. Mekkaoui, P. H. Rolland, A. Friggi, M. Rasigni, and T. G. Mesana Pressure-flow loops and instantaneous input impedance in the thoracic aorta: Another way to assess the effect of aortic bypass graft implantation on myocardial, brain, and subdiaphragmatic perfusion J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 699 - 710. [Abstract] [Full Text] [PDF]

				D. Spielvogel, M. N. Mathur, and R. B. Griepp Aneurysms of the Aortic Arch Card. Surg. Adult, January 1, 2003; 2(2003): 1149 - 1168. [Full Text]

				C. Hagl, N. Khaladj, D. J. Weisz, N. Zhang, L. J. Guo, C. A. Bodian, D. Spielvogel, and R. B. Griepp Impact of high intracranial pressure on neurophysiological recovery and behavior in a chronic porcine model of hypothermic circulatory arrest Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 510 - 516. [Abstract] [Full Text] [PDF]

				A. L. Estrera, C. C. Miller III, T. T.T. Huynh, E. E. Porat, and H. J. Safi Replacement of the ascending and transverse aortic arch: determinants of long-term survival Ann. Thorac. Surg., October 1, 2002; 74(4): 1058 - 1065. [Abstract] [Full Text] [PDF]