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J Thorac Cardiovasc Surg 2003;125:472-480
© 2003 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Tissue oxygen tension during regional low-flow perfusion in neonates

From the Divisions of Pediatric Cardiothoracic Surgery^a and Anesthesia and Critical Care Medicine,^b The Children's Hospital of Philadelphia, and the Department of Biochemistry and Biophysics,^c the University of Pennsylvania School of Medicine, Philadelphia, Pa.

Supported by provided by divisional funds and by the Healthcare Foundation of New Jersey.

Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 6-8, 2002.

Received for publication May 29, 2002. Revisions requested July 8, 2002; revisions received Aug 14, 2002. Accepted for publication Sept 13, 2002. Address for reprints: William M. DeCampli, MD, PhD, Division of Cardiothoracic Surgery, 8th Floor Main, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104 (E-mail: decampli{at}email.chop.edu).

Objective: We examined cerebral cortical and peripheral organ tissue PO₂ values in a neonatal piglet model of regional low-flow perfusion.
Methods: Twenty-one neonatal piglets were placed on cardiopulmonary bypass, were cooled to 18°C, then underwent either deep hypothermic circulatory arrest or regional low-flow perfusion at 20 or 40 mL/(kg x min) for 90 minutes. Regional low-flow perfusion was carried out by advancing the aortic cannula into the proximal innominate artery. Tissue mean PO₂ and PO₂ distribution were measured in the cerebral cortex, liver, small bowel, and skeletal muscle through the principle of oxygen-dependent quenching of phosphorescence. Measured quantities were compared by analysis of variance or the Fisher exact test.
Results: During regional low-flow perfusion, axillary and femoral arterial pressures, respectively, were 55 ± 15 and 8 ± 4 mm Hg at 40 mL/(kg x min) and 37 ± 10 mm Hg (P = .04) and 17 ± 5 mm Hg (P = .08) at 20 mL/(kg x min). Venous saturations were 95% ± 6% at 40 mL/(kg x min) and 84% ± 6% at 20 mL/(kg x min) (P = .03 at 15, 30, and 45 minutes). Cortical PO₂ was similar to prebypass values during regional low-flow perfusion at 40 mL/(kg x min) (53 ± 5 mm Hg) but declined during reperfusion and recovery. Cortical PO₂ was lower than before bypass during low-flow perfusion at 20 mL/(kg x min) (38 ± 7 mm Hg) but increased during reperfusion. PO₂ in liver and bowel was less than 10 mm Hg during low-flow perfusion at both 20 and 40 mL/(kg x min). Fraction of oxygen distribution with PO₂ lower than 15 mm Hg was less during perfusion at 40 mL/(kg x min) than at 20 mL/(kg x min) (P = .001). Three of 6 piglets that received a 40-mL/(kg x min) flow rate had significant upper torso edema, metabolic acidosis, and an unstable recovery period, whereas zero of 6 piglets that received a 20-mL/(kg x min) flow rate did.
Conclusions: In a piglet model, regional low-flow perfusion at 20 mL/(kg x min) resulted in lower cortical tissue oxygenation but better recovery than did perfusion at 40 mL/(kg x min). Neither flow rate adequately oxygenated organs in the lower torso.

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