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): William M. DeCampli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Myung, R. J. Articles by DeCampli, W. M. Search for Related Content PubMed PubMed Citation Articles by Myung, R. J. Articles by DeCampli, W. M.

J Thorac Cardiovasc Surg 2004;127:1051-1057
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Regional low-flow perfusion improves neurologic outcome compared with deep hypothermic circulatory arrest in neonatal piglets

^a Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
^b Departments of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
^c Department of Critical Care and Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
^d Department of Biostatistics and Epidemiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication May 2, 2003; revisions received August 25, 2003; revisions received November 4, 2003; accepted for publication November 11, 2003.

^* Address for reprints: William M. DeCampli, MD, PhD, Division of Cardiothoracic Surgery, Ste 8527, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA
decampli{at}email.chop.edu

BACKGROUND: Regional low-flow perfusion is an alternative to deep hypothermic circulatory arrest, but whether regional low-flow perfusion improves neurologic outcome after deep hypothermic circulatory arrest in neonates remains unknown. We tested neurologic recovery after regional low-flow perfusion compared with deep hypothermic circulatory arrest in a neonatal piglet model.

METHODS: Sixteen neonatal piglets underwent cardiopulmonary bypass, were randomized to 90 minutes of deep hypothermic circulatory arrest or regional low-flow perfusion (10 mL · kg^–1 · min^–1) at 18°C, and survived for 1 week. Standardized neurobehavioral scores were obtained on postoperative days 1, 3, and 7 (0 = no deficit to 90 = brain death). Histopathologic scores were determined on the basis of the percentage of injured and apoptotic neurons in the neocortex and hippocampus by hematoxylin and eosin and terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate–biotin nick-end labeling (0 = no injury to 4 = diffuse injury). Differences between groups were tested by using the Wilcoxon rank sum test, and results are listed as medians within a range.

RESULTS: There were no significant differences between groups during cardiopulmonary bypass. Postoperative neurobehavioral scores were abnormal in 25% (2/8) of the regional low-flow perfusion animals versus 88% (7/8) of controls. Regional low-flow perfusion animals had significantly less neurologic injury compared with controls on postoperative day 1 (0.00 [range, 0-5] vs 12.5 [range, 0-52]; P < .008). There was a trend for less severe injury in the regional low-flow perfusion group (2.0 [range, 1-4] vs 0.0 [range, 0-50]; P = .08) on hematoxylin and eosin. The degree of apoptosis was significantly less in the regional low-flow perfusion group (0.0 [range, 0-1] vs 2.5 [range, 0-4]; P = .03).

CONCLUSIONS: Regional low-flow perfusion decreases neuronal injury and improves early postoperative neurologic function after deep hypothermic circulatory arrest in neonatal piglets.

This article has been cited by other articles:

				C. S. Goldberg, E. L. Bove, E. J. Devaney, E. Mollen, E. Schwartz, S. Tindall, C. Nowak, J. Charpie, M. B. Brown, T. J. Kulik, et al. A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: Outcomes for infants with functional single ventricle J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 880 - 887. [Abstract] [Full Text] [PDF]

				E. Hickey, T. Karamlou, X. You, C. Komanapalli, T. Person, K. Wehrley, and R. Ungerleider The Use of a Miniaturized Circuit and Bloodless Prime To Avoid Cerebral No-Reflow After Neonatal Cardiopulmonary Bypass Ann. Thorac. Surg., March 1, 2007; 83(3): 895 - 901. [Abstract] [Full Text] [PDF]

				K. J. Visconti, D. Rimmer, K. Gauvreau, P. del Nido, J. E. Mayer Jr, I. Hagino, and F. A. Pigula Regional Low-Flow Perfusion Versus Circulatory Arrest in Neonates: One-Year Neurodevelopmental Outcome Ann. Thorac. Surg., December 1, 2006; 82(6): 2207 - 2213. [Abstract] [Full Text] [PDF]

				O. Roerick, T. Seitz, P. Mauser-Weber, T. Palmaers, M. Weyand, and R. Cesnjevar Low-flow perfusion via the innominate artery during aortic arch operations provides only limited somatic circulatory support. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 517 - 524. [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.

				C. L. Dent, J. P. Spaeth, B. V. Jones, S. M. Schwartz, T. A. Glauser, B. Hallinan, J. M. Pearl, P. R. Khoury, and C. D. Kurth Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 190 - 197. [Abstract] [Full Text] [PDF]

				C. L. Dent, J. P. Spaeth, B. V. Jones, S. M. Schwartz, T. A. Glauser, B. Hallinan, J. M. Pearl, P. R. Khoury, and C. D. Kurth Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1523 - 1530. [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]

				F. L. Hanley Religion, politics...deep hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1236 - 1236. [Full Text] [PDF]