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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 878-884, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RC Robbins, RS Balaban and JA Swain
A system has been developed for the nuclear magnetic resonance
spectroscopic evaluation of cerebral high-energy phosphate levels during
hypothermic total circulatory arrest and reperfusion by means of
cardiopulmonary bypass in large animals. The use of intermittent
hypothermic asanguineous cerebral perfusion, termed cerebroplegia, for the
preservation of cerebral high-energy phosphates during a 2-hour period of
hypothermic total circulatory arrest and reperfusion has been evaluated.
Cardiopulmonary bypass was used to achieve deep hypothermia (12 degrees to
15 degrees C) during 2 hours of circulatory arrest and reperfusion.
Juvenile sheep were divided into two groups. Group 1 animals (n = 8) (no
cerebroplegia) served as the control group. In group 2 animals (n = 7),
cerebroplegia was established by intermittent bilateral carotid artery
infusion of a hypothermic oxygenated asanguineous cardioplegic solution.
Nuclear magnetic resonance spectroscopy recorded changes in cerebral
adenosine triphosphate, creatine phosphate, and intracellular pH. Adenosine
triphosphate, creatine phosphate, and pH were higher in the group 2 animals
for all points during the arrest period and until 60 minutes after
reperfusion (p less than 0.05). Electroencephalographic activity returned
after 36 minutes of reperfusion in group 2, but it did not return until 117
minutes in group 1 (p less than 0.05). In summary, cerebral high-energy
phosphates and pH were maintained and the electroencephalographic signal
returned more rapidly during circulatory arrest with the institution of
cerebroplegia. These studies suggest that cerebroplegia is protective of
the brain during circulatory arrest.
ARTICLES
Intermittent hypothermic asanguineous cerebral perfusion (cerebroplegia) protects the brain during prolonged circulatory arrest. A phosphorus 31 nuclear magnetic resonance study
Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.
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