HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aoki, M. Articles by Holtzman, D. H. Search for Related Content PubMed PubMed Citation Articles by Aoki, M. Articles by Holtzman, D. H.

The Annals of Thoracic Surgery, Vol 58, 146-153, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Effects of aprotinin on acute recovery of cerebral metabolism in piglets after hypothermic circulatory arrest

M Aoki, RA Jonas, F Nomura, ME Stromski, MK Tsuji, PR Hickey and DH Holtzman
Department of Cardiovascular Surgery, Children's Hospital, Boston, Massachusetts 02115.

Brain protection during cardiopulmonary bypass and hypothermic circulatory arrest is incomplete. Activation of blood protease cascades may contribute to cellular injury under these conditions. To test this hypothesis, effects of the protease inhibitor aprotinin on recovery of brain energy metabolism after hypothermic circulatory arrest were studied in the piglet. Twenty-four 4-week-old piglets (10 aprotinin- treated and 14 control) underwent core cooling, 1 hour of circulatory arrest at 15 degrees C, reperfusion and rewarming (45 minutes), and normothermic perfusion (3 hours) on cardiopulmonary bypass. Cerebral high-energy phosphate concentration and intracellular pH were studied by phosphorus-31 magnetic resonance spectroscopy in 12 animals. In the remaining animals cerebral and regional blood flow were measured with radioactive microspheres and carotid artery blood flow was measured with an electromagnetic flowmeter. Cerebral oxygen and glucose extraction were measured, and vascular resistance responses to endothelium-dependent (acetylcholine) and -independent (nitroglycerin) vasodilators were calculated. Recovery of cerebral adenosine triphosphate (p = 0.02) and intracellular pH (p = 0.04) in the initial 30 minutes of reperfusion was accelerated in the aprotinin-treated piglets. These piglets showed a greater in vivo cerebral and systemic endothelium-mediated vasodilation (acetylcholine response: cerebral p < 0.01, systemic p = 0.04) after reperfusion. The response to endothelium- independent vasodilation (nitroglycerin) was the same in both groups. Carotid blood flow tended to be greater at 20 minutes of reperfusion and less during 45 to 80 minutes after reperfusion in the aprotinin- treated animals. Brain water content postoperatively was 0.8077 in the aprotinin group and 0.8122 in control animals (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				Y. Iwata, O. Nicole, T. Okamura, D. Zurakowski, and R. A. Jonas Aprotinin confers neuroprotection by reducing excitotoxic cell death J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 573 - 578. [Abstract] [Full Text] [PDF]

				E. B. Mossad, S. Machado, and J. Apostolakis Bleeding following deep hypothermia and circulatory arrest in children. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 34 - 46. [Abstract] [PDF]

				G. M. Hoffman Neurologic Monitoring on Cardiopulmonary Bypass: What Are We Obligated to Do? Ann. Thorac. Surg., June 1, 2006; 81(6): S2373 - S2380. [Abstract] [Full Text] [PDF]

				T.-Y. Hsia and P. J. Gruber Factors Influencing Neurologic Outcome After Neonatal Cardiopulmonary Bypass: What We Can and Cannot Control Ann. Thorac. Surg., June 1, 2006; 81(6): S2381 - S2388. [Abstract] [Full Text] [PDF]

				G. Amir, C. Ramamoorthy, R. K. Riemer, V. M. Reddy, and F. L. Hanley Neonatal Brain Protection and Deep Hypothermic Circulatory Arrest: Pathophysiology of Ischemic Neuronal Injury and Protective Strategies Ann. Thorac. Surg., November 1, 2005; 80(5): 1955 - 1964. [Abstract] [Full Text] [PDF]

				D. C. Harmon, K. G. Ghori, N. P. Eustace, S. J. F. O'Callaghan, A. P. O'Donnell, and G. D. Shorten Aprotinin decreases the incidence of cognitive deficit following CABG and cardiopulmonary bypass: a pilot randomized controlled study: [L'aprotinine reduit l'incidence de deficit cognitif a la suite d'un PAC et de la circulation extracorporelle : une etude pilote randomisee et controlee] Can J Anesth, December 1, 2004; 51(10): 1002 - 1009. [Abstract] [Full Text] [PDF]

				T. A. Khan, C. Bianchi, P. Voisine, J. Feng, J. Baker, M. Hart, M. Takahashi, G. Stahl, and F. W. Sellke Reduction of myocardial reperfusion injury by aprotinin after regional ischemia and cardioplegic arrest J. Thorac. Cardiovasc. Surg., October 1, 2004; 128(4): 602 - 608. [Abstract] [Full Text] [PDF]

				M. J. Scallan Cerebral injury during paediatric heart surgery: perfusion issues Perfusion, July 1, 2004; 19(4): 221 - 228. [Abstract] [PDF]

				G. M. Hoffman, E. A. Stuth, R. D. Jaquiss, P. L. Vanderwal, S. R. Staudt, T. J. Troshynski, N. S. Ghanayem, and J. S. Tweddell Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 223 - 233. [Abstract] [Full Text] [PDF]

				J. S. Tweddell, G. M. Hoffman, K. A. Mussatto, R. T. Fedderly, S. Berger, R. D. B. Jaquiss, N. S. Ghanayem, S. J. Frisbee, and S. B. Litwin Improved Survival of Patients Undergoing Palliation of Hypoplastic Left Heart Syndrome: Lessons Learned From 115 Consecutive Patients Circulation, September 24, 2002; 106(12_suppl_1): I-82 - I-89. [Abstract] [Full Text] [PDF]

				J. M. Murkin Adverse Central Nervous System Outcomes After Cardiopulmonary Bypass: A Beneficial Effect of Aprotinin? Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 282 - 285. [Abstract] [PDF]

				G. E. Hill The Inflammatory Response to Cardiopulmonary Bypass-- Should It Be Treated? Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 229 - 235. [Abstract] [PDF]

				H. P. Grocott, H. Sheng, Y. Miura, S. Sarraf-Yazdi, G. B. Mackensen, R. D. Pearlstein, and D. S. Warner The Effects of Aprotinin on Outcome from Cerebral Ischemia in the Rat Anesth. Analg., January 1, 1999; 88(1): 1 - 7. [Abstract] [Full Text] [PDF]

				P. Pouard Review of Efficacy Parameters Ann. Thorac. Surg., June 1, 1998; 65(90060): S40 - 44. [Abstract] [Full Text] [PDF]

				G. E. Hill, A. Alonso, J. R. Spurzem, A. H. Stammers, and R. A. Robbins APROTININ AND METHYLPREDNISOLONE EQUALLY BLUNT CARDIOPULMONARY BYPASS-INDUCED INFLAMMATION IN HUMANS J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1658 - 1662. [Abstract] [Full Text]