JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

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

J Thorac Cardiovasc Surg 2008;135:784-791
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Optimizing selective cerebral perfusion: Deleterious effects of high perfusion pressures

James C. Halstead, MA (Cantab) MB BChir, MD, MRCS (Eng)a,*, Matthias Meier, MDa, Michael Wurm, MDa, Ning Zhang, MDa, David Spielvogel, MDa, Donald Weisz, PhDb, Carol Bodian, DrPHc, Randall B. Griepp, MDa

a Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY
b Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY
c Department of Biomathematics, Mount Sinai School of Medicine, New York, NY

Received for publication May 25, 2007; revisions received August 13, 2007; accepted for publication September 6, 2007.

* Address for reprints: James C. Halstead MA (Cantab) MB BChir MRCS (Eng), Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029. (Email: jameschalstead{at}yahoo.co.uk).

Objective: Selective cerebral perfusion is a proven adjunct to hypothermia for neuroprotection in complex aortic surgery. The ideal conditions for the provision of selective cerebral perfusion, however, including optimal perfusion pressure, remain unknown. We investigated the effects of various perfusion pressures during selective cerebral perfusion on cerebral physiology and outcome in a long-term porcine model.

Methods: Thirty piglets (26.3 ± 1.4 kg), cooled to 20°C on cardiopulmonary bypass with {alpha}-stat pH management (mean hematocrit 23.6%), were randomly assigned to 90 minutes of selective cerebral perfusion at a pressure of 50 (group A), 70 (group B), or 90 (group C) mm Hg. With fluorescent microspheres and sagittal sinus sampling, cerebral blood flow and cerebral oxygen metabolism were assessed at baseline, after cooling, at two points during selective cerebral perfusion, and for 2 hours after cardiopulmonary bypass. Visual evoked potentials were monitored during recovery. Neurobehavioral scores were assessed blindly from standardized videotaped sessions for 7 postoperative days.

Results: Cerebral blood flow during selective cerebral perfusion was significantly increased by higher-pressure perfusion (P = .04), although all groups sustained similar levels of cerebral oxygen metabolism during selective cerebral perfusion (P = .88). After the end of cardiopulmonary bypass, the cerebral oxygen metabolism increased to above baseline in all groups, with the highest levels seen in group C (P = .06). Intracranial pressure was significantly higher during selective cerebral perfusion in group C (P = .0002); visual evoked potentials did not differ among groups. Neurobehavioral scores were significantly better in group A (P = .0002).

Conclusion: Selective cerebral perfusion at 50 mm Hg provides neuroprotection superior to that at higher pressures. The increased cerebral blood flow with higher-pressure selective cerebral perfusion is associated with cerebral injury, reflected by high post–cardiopulmonary bypass cerebral oxygen metabolism and poorer neurobehavioral recovery.

Abbreviations and Acronyms CBF = cerebral blood flow; CMRO 2 = cerebral metabolic rate for oxygen; CPB = cardiopulmonary bypass; ICP = intracranial pressure; SCP = selective antegrade cerebral perfusion; SSP = sagittal sinus pressure; SSSO 2 = sagittal sinus oxygen saturation; VEP = visual evoked potential




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
C. D. Etz, M. Luehr, F. A. Kari, H. M. Lin, G. Kleinman, S. Zoli, K. A. Plestis, and R. B. Griepp
Selective cerebral perfusion at 28 {degrees}C -- is the spinal cord safe?
Eur. J. Cardiothorac. Surg., December 1, 2009; 36(6): 946 - 955.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. D. Schmoker, C. Terrien III, K. J. McPartland, J. Boyum, G. C. Wellman, L. Trombley, and J. Kinne
Cerebrovascular response to continuous cold perfusion and hypothermic circulatory arrest.
J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 459 - 464.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. G.T. Augoustides
Optimizing selective cerebral perfusion in adult aortic arch repair: clinical relevance of the laboratory model.
J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 1105 - 1106.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.