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The Annals of Thoracic Surgery, Vol 43, 391-396, Copyright © 1987 by The Society of Thoracic Surgeons
IM Rebeyka, JG Coles, GJ Wilson, T Watanabe, MJ Taylor, SF Adler, DA Mickle, AD Romaschin, H Ujc and FA Burrows
Systemic flow rates (Q) during nonpulsatile hypothermic cardiopulmonary
bypass (CPB) that are consistent with preservation of cerebral function
have not to our knowledge been objectively defined. The effect of a
sequential reduction in flow rates on cerebral cortical metabolism and
function was evaluated in 6 mongrel dogs during hypothermic (25 degrees C)
CPB. Cerebral function was assessed using somatosensory cortical evoked
potentials (SSEP); cerebral metabolism was assessed by adenosine
triphosphate (ATP) and lactate content of snap-frozen gray matter biopsies
taken from the hemisphere contralateral to that monitored for SSEP. A
progressive decline in ATP levels was observed during flow reduction with
virtually complete depletion of ATP at 0.25 L min-1 m- 2(p = .0003). The
significant (p = .028) dependence of cortical ATP levels on perfusion
pressure was no longer evident after adjusting for the effects of flow
rate. Lactate levels increased during flow reduction (p = .028), especially
at flow rates less than 0.5 L min-1 m- 2. Somatosensory neural transmission
remained intact until flow was reduced to 0.25 L min-1 m-2 in 5 animals and
until total circulatory arrest in 1, at which time loss of the signal
occurred. In addition, 5 patients were subjected to brief periods of
low-flow CPB (Q = 1.0 L min- 1 m-2) at 21 degrees to 25 degrees C. SSEPs
remained intact during flow reduction, and postoperative neurologic
evaluation was normal in all patients. We conclude that, in the absence of
cerebral vascular disease, the flow rate threshold for incurring functional
cerebral injury during hypothermic (25 degrees C) nonpulsatile CPB is less
than 1.0 L min-1 m-2.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The effect of low-flow cardiopulmonary bypass on cerebral function: an experimental and clinical study
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