Does antegrade cerebral perfusion protect the brain during deep hypothermic circulatory arrest?

Mahan, Vicki; Ilangovan, Saroja; Cuison, Reuben; Patil, Jyothi; Dockter, Sarah; Rizzo, Vince; Ilbawi, Michel N.

doi:10.1016/j.jpedsurg.2004.11.043

Cited by 7 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mahan et al. (6) found that at 30 min after CPB, serum S‐100B levels and lactate‐to‐pyruvate ratio displayed no differences when various flow rates (10, 25, and 50 mL/kg/min) for ACP were used in a piglet model. These results are partly incompatible with ours.…”

Section: Discussionmentioning

confidence: 99%

“…The ACP flows ranging from 20 to 92 mL/kg/min were applied to neonates/infants undergoing deep or moderate hypothermic circulatory arrest among different centers (1–4). Moreover, the results based on experimental studies on the optimal flows for ACP were inconsistent (5–8).…”

mentioning

confidence: 99%

“…(13) found the ACP flows that closely match standard cardiopulmonary bypass (CPB) conditions were 30–50 mL/kg/min in a piglet model; however, they did not use histological comparison. Several studies on apoptotic neuronal injury determined by immunology and histology after combined DHCA and ACP displayed incompatible results in piglet models (5,6,8). To date, the ACP flow that provides the best or definite brain protection remains unclear.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The Optimal Flow Rate for Antegrade Cerebral Perfusion During Deep Hypothermic Circulatory Arrest

Chen¹,

Liu²,

Ji³

et al. 2012

Artificial Organs

View full text Add to dashboard Cite

The aim of this study is to compare cerebral protection using antegrade cerebral perfusion (ACP) with various flow rates during deep hypothermic circulatory arrest (DHCA) in a piglet model. Twenty-three piglets were randomized to five groups: the control group (n = 3), DHCA group (n = 5), ACP25 group (n = 5), ACP50 group (n = 5), and ACP80 group (n = 5). Three control piglets did not undergo operations. Twenty piglets underwent cardiopulmonary bypass (CPB) and DHCA for 60 min at 20°C. ACP was conducted at 0, 25, 50, and 80 mL/kg/min in the DHCA, ACP25, ACP50, and ACP80 group, respectively. Serum S-100B protein and neuron-specific enolase were monitored, and brain tissues were assayed for the activities of caspase-3 and stained for the evidence of apoptotic cellular injury. Rise in serum S-100B level (post-CPB-pre-CPB) in the ACP50 group was significantly lower than that in the ACP80 group (P = 0.001). Caspase-3 levels were significantly elevated in the ACP80 group compared with the ACP25 (P = 0.041) and ACP50 group (P = 0.01), while positive terminal deoxyneucleotidyl transferase-mediated biotin-dUTP nick end labeling reaction scores in the ACP80 group were significantly higher than those in the ACP25 (P = 0.043) and ACP50 group (P = 0.023). Cerebral protection effects of ACP at 25 and 50 mL/kg/min were superior to that of ACP at 80 mL/kg/min as determined by cerebral markers, immunology, and histology.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The Optimal Flow Rate for Antegrade Cerebral Perfusion During Deep Hypothermic Circulatory Arrest

Chen¹,

Liu²,

Ji³

et al. 2012

Artificial Organs

View full text Add to dashboard Cite

show abstract

“…Pediatric surgeons accepted to implement this technique for hypoplastic left heart syndrome first stage palliation or aortic arch surgery ( 36 , 37 ). The benefits were disappointing compared to circulatory arrest, and several works failed to find any positive effect of antegrade cerebral perfusion ( 38 – 41 ). The appropriate hypothermic brain perfusion rate and pressure for neonates remain unknown.…”

Section: Evolution Of the Dogma On Hypothermia Protective Effect Durimentioning

confidence: 99%

Rationale for Implementation of Warm Cardiac Surgery in Pediatrics

Durandy

2016

Front. Pediatr.

View full text Add to dashboard Cite

Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia–reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.

show abstract

“…Various flow rates (10-50 ml kg À1 min À1 ) have been used both clinically, and during SCP in piglet experimental models [1,4,16]. DeCampli et al reported that 50% of piglets undergoing SCP with a flow rate of 40 ml kg À1 min À1 had significant upper torso oedema, metabolic acidosis, and an unstable recovery period, but that none of piglets perfused with 20 ml kg À1 min À1 had such complications [4] suggesting a deleterious effect of increased flow.…”

Section: Flow Rate During Scpmentioning

confidence: 99%

Hypothermic extracorporeal circulation in immature swine: a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest☆

Sasaki

Guleserian

Rose

et al. 2009

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.

show abstract

Does antegrade cerebral perfusion protect the brain during deep hypothermic circulatory arrest?

Cited by 7 publications

References 24 publications

The Optimal Flow Rate for Antegrade Cerebral Perfusion During Deep Hypothermic Circulatory Arrest

The Optimal Flow Rate for Antegrade Cerebral Perfusion During Deep Hypothermic Circulatory Arrest

Rationale for Implementation of Warm Cardiac Surgery in Pediatrics

Hypothermic extracorporeal circulation in immature swine: a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest☆

Contact Info

Product

Resources

About