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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 124-132, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Tanaka, K Shiki, T Asou, H Yasui and K Tokunaga
We evaluated effects of hypothermic cardiopulmonary bypass on the cerebral
circulation and metabolism of six dogs over a temperature range of 37
degrees to 20 degrees C under alphastat acid-base regulation (uncorrected
for body temperature). Cerebral metabolic rate for oxygen was determined
from the difference between arterial and sagittal sinus blood oxygen
contents, and direct cerebral blood flow measurements of the venous outflow
from the isolated sagittal sinus. After core cooling at a constant
perfusion flow rate of 80 ml/kg/min, cerebral blood flow significantly
reduced to 10.0 +/- 1.1 ml/100 gm/min at 20 degrees C (20% +/- 2% of that
at 37 degrees C) because of an increase in the cerebral vascular resistance
(339% +/- 48%). Cerebral metabolic rate for oxygen reduced to 18% +/- 2%.
The upper body vascular resistance decreased to a greater extent than the
lower body resistance (37% +/- 4% versus 82% +/- 12%). In the selective
cerebral perfusion system at 20 degrees C, when perfusion pressure (mean
carotid arterial pressure minus central venous pressure) was lowered from
90 mm Hg by graded reduction of the perfusion flow rate, cerebral blood
flow remained constant down to a perfusion pressure of 40 mm Hg, then
steeply declined. Cerebral metabolic rate for oxygen also kept a constant
level down to 30 mm Hg, then fell abruptly. Definite autoregulatory
response was detected even in profound hypothermic nonpulsatile
cardiopulmonary bypass. These results suggest that cerebral perfusion flow
should be regulated so as to keep the perfusion pressure within the range
of cerebral autoregulation to prevent cerebral ischemia or hyperperfusion,
especially during selective cerebral perfusion for operations on the aortic
arch.
ARTICLES
Cerebral autoregulation during deep hypothermic nonpulsatile cardiopulmonary bypass with selective cerebral perfusion in dogs
Division of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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