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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 76-83, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA Swain, TJ McDonald Jr, PK Griffith, RS Balaban, RE Clark and T Ceckler
Cerebral protection during surgical procedures necessitating circulatory
arrest or low flow remains the factor that most limits the critical time
for repair of lesions. In vivo phosphorus-31 nuclear magnetic resonance
spectroscopy was used to assess the metabolic state of the brain during
circulatory arrest by measuring the concentration of high-energy phosphate
compounds and the intracellular pH. The degree of cerebral protection
during deep hypothermic cardiopulmonary bypass at low flow rates was
compared with that obtained with a period of circulatory arrest interrupted
by intermittent systemic perfusion. Sheep were instrumented with cannulas
for cardiopulmonary bypass, and a radiofrequency coil was positioned on the
skull. Animals were placed in the bore of a 4.7 Tesla magnet, cooled with
the aid of cardiopulmonary bypass to 15 degrees C, and had either
circulatory arrest (n = 5) or continuous low flow rates of 5 ml/kg/min (n =
6) or 10 ml/kg/min (n = 7) for 2 hours. A fourth group (n = 5) underwent 1
hour of circulatory arrest, systemic reperfusion for 30 minutes, then
another hour of circulatory arrest. Both circulatory arrest and a flow rate
of 5 ml/kg/min resulted in severe intracellular acidosis and depletion of
high-energy phosphates. A flow of 10 ml/kg/min preserved high-energy
phosphates and intracellular pH. Therefore deep hypothermia with
cardiopulmonary bypass flows as low as 10 ml/kg/min can maintain brain
high-energy phosphate concentrations and intracellular pH for 2 hours in
sheep, whereas flows of 5 ml/kg/min or intermittent full-flow systemic
perfusion between periods of circulatory arrest offers less protection.
Previous studies from our laboratory have shown that improvement in nuclear
magnetic resonance parameters positively correlates with improved survival
and preservation of neurologic function.
ARTICLES
Low-flow hypothermic cardiopulmonary bypass protects the brain
Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
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