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J Thorac Cardiovasc Surg 2006;132:1312-1313
© 2006 The American Association for Thoracic Surgery

DiscussionCardiopulmonary Support and Physiology: Discussion

Discussion

Dr Anthony Azakie (San Francisco, Calif). Dr. Mitchell, Dr. Cohen, I’d like to thank the association for the opportunity to comment on this paper. Dr. Amir, thank you for sending me a copy of the manuscript before the meeting. I found this study very interesting and timely. Selective cerebral perfusion has become a more prevalent strategy during neonatal arch reconstruction. We routinely use selective cerebral perfusion during stage I palliation for hypoplastic left heart syndrome as well as for repair of arch interruption or arch hypoplasia.

A significant number of studies have reported on the deleterious effects of deep hypothermic circulatory arrest, and clinical data have prompted a move away from the routine use or prolonged use of circulatory arrest. Recently, more information is becoming available in attempting to characterize both the favorable and the adverse effects of regional low-flow perfusion to the head. Further detailed assessments of the optimal conditions for regional low-flow perfusion are necessary, and this study provides us with some additional laboratory data that may have clinical implications.

In summary, this study uses visible light spectroscopy in a pig model to assess cerebral oxygenation. You have presented a number of important observations, and in the manuscript the authors conclude that regional low-flow perfusion rates in humans should be kept between 30 to 40 cc/kg/minute.

I have a number of questions and comments regarding the study and the supporting manuscript. First, the group from the Texas Children’s Hospital has shown that bilateral monitoring during neonatal arch reconstruction detects significant desaturation in the left cerebral hemisphere, suggesting that there is asymmetric cerebral oxygenation during regional low-flow perfusion through the human innominate artery. Furthermore, at UCSF we have monitored bilateral cerebral oxygenation during coarctation repair and found that . . . [Full Text of this Article]

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Visual light spectroscopy reflects flow-related changes in brain oxygenation during regional low-flow perfusion and deep hypothermic circulatory arrest

Gabriel Amir, Chandra Ramamoorthy, R. Kirk Riemer, Corrine R. Davis, Frank L. Hanley, and V. Mohan Reddy
J. Thorac. Cardiovasc. Surg. 2006 132: 1307-1312. [Abstract] [Full Text] [PDF]