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J Thorac Cardiovasc Surg 2000;119:856-857
© 2000 The American Association for Thoracic Surgery

LETTERS TO THE EDITOR

A possible explanation for the failure to improve the internal jugular venous oxygen saturation with balloon pump–induced pulsatile perfusion

Yuji Kadoi, MD, Shigeru Saito

Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan

Reply to the Editor:

We appreciate the comments of Miyamoto and Miyamoto. As we described previously, it is not clear which type of pulsatile waveform has positive effects on cerebral circulation and improves outcome of patients.Go 1

The internal jugular venous oxygen saturation (SjvO 2) value expressed in Fig 1 was the value measured in a blood sample drawn from a jugular venous catheter. At the same time, we continuously measured the SjvO 2 value and regional cerebral oxygenation using an analysis system (Explorer system, Baxter Healthcare Corp, Irvine, Calif) and found that there were no changes in the SjvO 2 and regional cerebral oxygenation values throughout the study. In our previous study,Go 2 we reported a close correlation between the oxygen saturation value measured by the optical catheter and the oxygen saturation value in sampled blood by the blood gas analyzer. Therefore we do not think that the change in Sjvo2 would be observed if the value had been measured more frequently during cardiopulmonary bypass (CPB). It remains controversial whether cerebral autoregulation is intact during CPB.Go Go 3,4 Newman and associatesGo 3 reported that an increase in cerebral blood flow was observed by an increase in mean arterial pressure. In contrast, Sadahiro and the associatesGo 4 reported that cerebral blood flow was constant when mean arterial pressure was higher than 50 mm Hg. At present, there is no solid agreement concerning the acceptable level of mean arterial pressure during CPB.

As we described previously, however, our pulse pressure was a physiologic pulse waveform. A higher pulse pressure (>40 mm Hg) might have had a positive effect of high-pressure intra-aortic balloon pumping (IABP) on cerebral circulation.Go 1

We did not measure the plasma catecholamine levels in the two groups; therefore it was not known whether plasma levels could have some effects on cerebral microcirculation in our study. Cerebral microcirculation might be affected by plasma catecholamine level, as they described. However, other factors, such as renin-angiotensin and thromboxane A2, might have effects on cerebral microcirculation.Go 5

12/8/104876 doi:10.1067/mtc.2000.104876

References

  1. Kadoi Y, Saito S. Balloon pump–induced pulsatile perfusion during cardiopulmonary bypass does not improve brain oxygenation [letter reply]. J Thorac Cardiovasc Surg 2000;119:189-90. [Free Full Text]
  2. Kadoi Y, Kawahara F, Saito S, et al. Effects of hypothermic and normothermic cardiopulmonary bypass on brain oxygenation. Ann Thorac Surg 1999;68:34-9. [Abstract/Free Full Text]
  3. Newman MF, Croughwell ND, White WD, et al. Effect of perfusion pressure on cerebral blood flow during normothermic cardiopulmonary bypass. Circulation 1996;94(Suppl):II-353-7.
  4. Sadahiro M, Haneda K, Mohri H. Experimental study of cerebral autoregulation during cardiopulmonary bypass with or without pulsatile perfusion. J Thorac Cardiovasc Surg 1994;108:446-54. [Abstract/Free Full Text]
  5. Hornick P, Taylor K. Pulsatile and nonpulsatile perfusion: the continuing controversy. J Cardiothorac Vasc Anesth 1997;11:310-5. [Medline]




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