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J Thorac Cardiovasc Surg 2006;132:80-88
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Intermittent pressure augmentation during retrograde cerebral perfusion under moderate hypothermia provides adequate neuroprotection: An experimental study

Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Received for publication June 21, 2005; revisions received December 27, 2005; accepted for publication January 10, 2006.

^_* Address for reprints: Mitsuhiro Kawata, MD, Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. (Email: mkawata-ths{at}umin.ac.jp).

OBJECTIVE: For cerebral protection during aortic surgery, we introduced a novel retrograde cerebral perfusion method with intermittent pressure augmentation. We then assessed whether this novel method provides benefits similar to those provided by antegrade selective cerebral perfusion.

METHODS: Eighteen dogs were randomly divided into 3 groups: the RCP-INT group, intermittent-retrograde cerebral perfusion at 15 mm Hg with intermittent pressure augmentation to 45 mm Hg (n = 6); the ASCP group, antegrade selective cerebral perfusion at a flow rate of 10 mL · kg^–1 · min^–1 (n = 6); and the sham group, no circulatory arrest (n = 6). Cooling (26°C) with cardiopulmonary bypass and 60 minutes of circulatory arrest were performed in the RCP-INT and ASCP groups. The levels of tau protein in the cerebrospinal fluid and the diameters of the retinal vessels were measured. The neurologic deficit scores and the histopathologic damage scores of the brains were determined.

RESULTS: The total postoperative tau protein levels (calculated as the area under the curve) did not differ significantly between the RCP-INT and ASCP groups (203 ± 87 pg · mL^–1 · h vs 154 ± 69 pg · mL^–1 · h, P = .95). The retinal vessels were effectively dilated at an augmented pressure of 45 mm Hg in the RCP-INT group. The total neurologic deficit score (0 = normal, 500 = brain death) and histopathologic damage score (0 = normal, 40 = worst) were not significantly different between the RCP-INT and ASCP groups (neurologic deficit score: 75 ± 21 vs 70 ± 21, P = .98; histopathologic damage score: 13.5 ± 1.5 vs 14.2 ± 1.3, P = .84).

CONCLUSIONS: Intermittent augmented pressure dilated the cerebral vessels, allowing adequate blood supply without injuring the brain. This retrograde cerebral perfusion method provides adequate neuroprotection during moderate hypothermia.

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