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J Thorac Cardiovasc Surg 2003;125:460-462
© 2003 The American Association for Thoracic Surgery

Editorials

Organ protection during hypothermic circulatory arrest

Axel Haverich, MD, Christian Hagl, MD

From the Klinik für Thorax-Herz-Gefässchirurgie, Medizinische Hochschule, Hannover, Germany.

Received for publication July 16, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Axel Haverich, MD, Medizinische Hochschule Hannover, Klinik f. Thorax-, Herz- u. Gefässchirurgie, Hannover, Germany D-30623.

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   Introduction
 
See related article on page 625.


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  		Haverich and Hagl

 
Since the first experimental studies by Bigelow and coworkers in the early 1950s, the use of hypothermic circulatory arrest (HCA) has become the standard technique for the surgical repair of certain congenital and acquired cardiovascular lesions. The outcome after these operations improved considerably over the past two decades and surgery requiring HCA can usually be performed with an acceptable risk for the patient. However, it is likely that these improvements are more a consequence of an increasing expertise with this type of surgery, rather than the influence of one particular organ protection method employed. Despite this fact, there is still room for improvement, since prolonged periods of HCA are still associated with significant morbidity and mortality.


   HCA and multiorgan dysfunction
 
The rationale for the use of HCA during cardiopulmonary bypass is based on the reduction of the metabolic rate of the tissues and the subsequent increase of the tolerance to ischemia. As the brain is the organ most sensitive to ischemic damage, it is considered to be the limiting factor for the duration of HCA. Nevertheless, despite its protective effects, HCA can be detrimental for other organ systems. Cooper and coworkers,Go 1 using a porcine model, were able to demonstrate that HCA was associated with endothelial dysfunction in the cerebral microvasculature as well as in large-caliber renal arteries and pulmonary veins. In addition, elevated liver and pancreatic serum enzyme levels can be clinically observed after prolonged periods of HCA (our own unpublished data). Not only HCA, but even cardiopulmonary bypass without HCA, is associated with significant physiologic alterations in the intestinal mucosal perfusion, epithelial permeability, edema formation, and blood flow regulation. In . . . [Full Text of this Article]


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Deep hypothermic circulatory arrest and global reperfusion injury: Avoidance by making a pump prime reperfusate—A new concept
Bradley S. Allen, Jeffrey S. Veluz, Gerald D. Buckberg, Ernesto Aeberhard, and Louis J. Ignarro
J. Thorac. Cardiovasc. Surg. 2003 125: 625-632. [Abstract] [Full Text] [PDF]



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