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J Thorac Cardiovasc Surg 2002;124:1261
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Naoki Washiyama, MD, Teruhisa Kazui, MD, Abul Hasan Muhammad Bashar, MBBS

First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan

Reply to the Editor:

We would like to thank Miyamoto and Miyamoto for their insightful comments on our article. We have the following opinion in response to their observations.

Recent studies have revealed the advantages of pH-stat management over alpha-stat management in infants.Go Go 1-3 In the old cerebral infarct model that we used in our study, we also presume that pH-stat management might prevent the progress of anaerobic metabolism as indicated by Miyamoto and Miyamoto. However, we do not know whether pH-stat management may improve the surgical results in adult patients with old cerebral infarction, because atheromatous microembolism may also be as important a factor as ischemia of the penumbra. Although the metabolism in the penumbra that we described may be improved by pH-stat management, microembolism will certainly not decrease; if anything, it will increase.Go 4 Most of the adult patients who undergo aortic arch operations have atherosclerosis in the aorta, arch vessels, and intracranial vessels. Patients with old cerebral infarction are especially likely to have severe atherosclerosis, whereas infants or young patients do not have any atherosclerosis. Moreover, blood flow of the penumbra would not necessarily increase in pH-stat management because there is a derangement of autoregulation in pH-stat management; this autoregulation is maintained in alpha-stat management.

We agree that pH-stat management has the potential of improving neurologic outcome in hypothermic operations. However, more investigations will be necessary to ascertain the actual merits of this strategy when applied in adult patients with severe atherosclerosis.

References

  1. Plessis AJ, Jonas RA, Wypoj D, Hickey PR, Riviello J, Wessel DL, et al. Perioperative effects of alpha-stat versus pH-stat strategies for deep hypotheric cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg. 1997;114:991-1001.[Abstract/Free Full Text]
  2. Priestley MA, Golden JA, O'Hara IB, McCann J, Kurth CD. Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs. J Thorac Cardiovasc Surg. 2001;121:336-43.
  3. Kurth CD, O'Rourke MM, O'Hara IB. Comparison of pH-stat and alpha-stat cardiopulmonary bypass on cerebral oxygenation and blood flow in relation to hypothermic circulatory arrest in piglets. Anesthesiology. 1998;89:110-8.[Medline]
  4. Patel RL, Turtle MR, Chambers DJ, James DN, Newman S, Venn GE. Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1996;111:1267-79.[Abstract/Free Full Text]




This Article
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Teruhisa Kazui
Abul Hasan Muhammad Bashar
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Right arrow Articles by Washiyama, N.
Right arrow Articles by Bashar, A. H. M.

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