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J Thorac Cardiovasc Surg 2002;124:413-416
© 2002 The American Association for Thoracic Surgery
Brief Communications |
From the Congenital Heart Surgery Service, Texas Children's Hospital,a the Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine,b the Cullen Cardiovascular Surgical Research Laboratories, Texas Heart Institute,c the Department of Biostatistics and Epidemiology, Texas Heart Institute,d and the Department of Pediatrics, Baylor College of Medicine,e Houston, Tex.
This study was supported by a grant from the American Heart Association, Texas Affiliate, to Dr Akif Ündar (grant 98BG197).
Received for publication Feb 7, 2002. Accepted for publication March 29, 2002. Address for reprints: Akif Ündar, PhD, Texas Children's Hospital/Baylor College of Medicine, Congenital Heart Surgery Service, 6621 Fannin St, Mail Code WT 19345-H, Houston, TX 77030-2399 (E-mail: aundar@bcm.tmc.edu).
| The first 300 words of the full text of this article appear below. |
To repair complex congenital heart defects, surgeons are required to use extreme techniques, such as cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). Several investigators have shown that DHCA has a significant adverse effect on the cerebral blood flow (CBF) and metabolism in neonates and infants, as well as in animal models.
1-3 However, we have shown, in a neonatal piglet model, that the use of pulsatile flow might minimize these adverse events by increasing the regional and global CBF, cerebral metabolic rate of oxygen, and cerebral oxygen delivery and by decreasing cerebral vascular resistance. 4 In a separate study we have also shown that, compared with nonpulsatile roller pumps, pulsatile roller pumps generate significantly more hemodynamic energy and increase cerebral, renal, and myocardial blood flow after DHCA. 5-7
The objectives of the present study were (1) to compare the effects of pulsatile perfusion versus nonpulsatile perfusion with a new pediatric roller pump equipped with a miniature roller head on regional and global CBF and on regional cerebral oxygen saturation (rSo2) and (2) to quantify and directly compare the resulting pressure and flow waveforms in terms of hemodynamic energy by using the energy equivalent pressure (EEP) formula. The EEP formula is the best for quantifying different modes of perfusion because it contains both pressure and flow waveforms and not just pressure waveforms alone. 8
Materials and methods
Animals
Fourteen piglets (mean weight, 3 kg) underwent either pulsatile perfusion (n = 7) or nonpulsatile perfusion (n = 7). All animals received humane care as described in the "Guide for the Care and Use of Laboratory Animals" of the National Research Council.
Perfusion protocol
Each piglet was premedicated with intramuscular ketamine hydrochloride (20 mg/kg) and acepromazine maleate (1 mg/kg; INN: acepromazine). An intravenous line was established, after which a 3-mm endotracheal tube was inserted for mechanical ventilation. Intravenous boluses of
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