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J Thorac Cardiovasc Surg 2005;130:670-676
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Pharmacologic cerebral capillary blood flow improvement after deep hypothermic circulatory arrest: An intravital fluorescence microscopy study in pigs

^a Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
^b Department of Anatomy, University of Cologne, Cologne, Germany.
^c Department of Experimental Medicine, University of Cologne, Cologne, Germany.

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23-26, 2004.

Received for publication November 23, 2004; revisions received February 24, 2005; accepted for publication March 21, 2005.

^_* Address for reprints: Lotfi Ben Mime, MD, Department of Cardiothoracic Surgery, University of Cologne, Josef-Stelzmann-Strasse 9, 50924 Cologne, Germany. (Email: Lofti.ben-mime{at}uk-koeln.de).

BACKGROUND: Despite meticulous investigation of bypass techniques for deep hypothermic circulatory arrest, unfavorable long-term neurologic deficits have been well documented. Our aim was to improve brain perfusion by reducing platelet plugging with a glycoprotein IIb/IIIa inhibitor (eptifibatide) in an experimental model of deep hypothermic circulatory arrest–reperfusion in pigs.

METHODS: Two groups of 12 piglets each (eptifibatide group [eptifibatide + unfractionated heparin] vs UFH group [only unfractionated heparin]) underwent 10 minutes of normothermic bypass, 40 minutes of cooling during cardiopulmonary bypass (hematocrit, 30%; cardiopulmonary bypass flow, 100 mL·kg^–1 ·min^–1), 60 minutes of circulatory arrest at 15°C, and a 40-minute rewarming period. Intravital fluorescence microscopy of pial vessels at set intervals was performed.

RESULTS: During the cooling period, there was a tendency toward reduced functional capillary density values without statistical significance in both groups. During reperfusion, the eptifibatide group demonstrated a significantly decreased platelet adhesion and aggregation (at 30 minutes of reperfusion: functional capillary density, 104% ± 3% vs 77% ± 4% relative to baseline, P = .02; red blood cell velocity, 0.65 vs 0.30 mm/s, P < .004). A more rapid recovery of tissue oxygenation (P < .001) was documented. Furthermore, a significant microvascular permeability reduction was achieved compared with that seen in the UFH group (P < .02). The use of eptifibatide resulted in fewer ultrastructural changes in hippocampal tissue, which is demonstrated by histologic examination.

CONCLUSIONS: Platelet plugging reduction with the glycoprotein IIb/IIIa inhibitor eptifibatide improves cerebral capillary blood flow and reduces cerebral ischemia in the setting of deep hypothermic circulatory arrest. Furthermore, significant endothelial cell injury and perivascular edema reduction can be achieved.

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