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Ann Thorac Surg 1994;57:96-101
© 1994 The Society of Thoracic Surgeons

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Articles

Cerebral metabolic effects of sequential periods of hypothermic circulatory arrest

Departments of Surgery and Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA

^_* Address reprint requests to Dr Mault, Department of Surgery, Duke University Medical Center, Box 3642, Durham, NC 27710.

During repair of congenital heart defects, extended periods of hypothermic circulatory arrest (CA) have been shown to cause short-term cerebral metabolic and flow abnormalities as well as long-term neuropsychologic dysfunction. Occasionally, a second period of CA is required during the same operative setting to revise a complicated repair. However, the metabolic effects of two consecutive periods of CA on the brain are unclear. In this study, we compared the recovery of cerebral metabolism after 60 minutes of CA with that after two sequential 30-minute periods of CA separated by a brief period of rewarming (30'SEQ). Fifteen neonatal piglets (2 to 3 kg) were placed on cardiopulmonary bypass at 100 mL · kg^–1 · min^–1 and cooled to 18 °C. Each animal then underwent either 60 minutes of uninterrupted cardiopulmonary bypass at 18 °C, 60 minutes of CA, or two 30-minute periods of CA separated by a brief period of rewarming. After these experimental periods, animals were rewarmed to 37 °C and weaned from cardiopulmonary bypass. Data were obtained before cardiopulmonary bypass and after cardiopulmonary bypass at 37 °C and included measurements of cerebral blood flow by xenon 133 clearance, arterial and sagittal sinus blood gases, and cerebral metabolism (mL O₂ · 100 g^–1 · min^–1). Our results demonstrated that acute recovery of cerebral metabolism was significantly impaired after 60 minutes of CA and that recovery of cerebral metabolism after two sequential 30-minute periods of CA was significantly better than after 60 minutes of continuous CA. In conclusion, the effects of a second period of CA on the brain are not additive, and therefore should not preclude revision of an inadequate repair.

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