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Ann Thorac Surg 1999;67:1895-1899
© 1999 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York, USA
Address reprint requests to Dr McCullough, Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Box 1028, One Gustave L. Levy Place, New York, NY 10029
Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.
Background. Hypothermic circulatory arrest (HCA) is used in surgery for aortic and congenital cardiac diseases. Although studies of the safety of HCA in animals have been carried out, the degree to which metabolism is suppressed in patients during hypothermia has been difficult to determine because of problems with serial measurements of cerebral blood flow in the clinical setting.
Methods. To quantify the degree of metabolic suppression achieved by hypothermia, we studied 37 adults undergoing operations employing HCA. Cerebral blood flow was estimated using an ultrasonic flow probe on the left common carotid artery, and cerebral arteriovenous oxygen content differences were calculated from jugular venous bulb and arterial oxygen saturations. Cerebral metabolic rates while cooling were then ascertained. The temperature coefficient, Q10, which is the ratio of metabolic rates at temperatures 10°C apart, was determined.
Results. The human cerebral Q10 was found to be 2.3. The cerebral metabolic rate is still 17% of baseline at 15°C. If one assumes that cerebral blood flow can safely be interrupted for 5 min at 37°C, and that cerebral metabolic suppression accounts for the protective effects of hypothermia, the predicted safe duration of HCA at 15°C is only 29 min.
Conclusions. The safe intervals calculated from measured cerebral oxygen consumption suggest that shorter intervals and lower temperatures than those currently used may be necessary to assure adequate cerebral protection during hypothermic circulatory arrest.
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C. Hagl, J. D. Galla, D. Spielvogel, S. L. Lansman, R. Squitieri, C. A. Bodian, M. A. Ergin, and R. B. Griepp Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable? Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 417 - 423. [Abstract] [Full Text] [PDF]
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T.-A. Miyamoto and K.-J. Miyamoto Alkalosis induced by alpha-stat management: Cause of neuronal injury after deep hypothermic perfusion J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 817 - 818. [Full Text] [PDF]
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R. B. Griepp Cerebral protection during aortic arch surgery J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 425 - 427. [Full Text] [PDF]
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T. Juvonen, V. Anttila, J. Rimpilainen, M. Pokela, V. Vainionpaa, and K. Kiviluoma Reply J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 597 - 598. [Full Text] [PDF]
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J. Rimpilainen, M. Pokela, K. Kiviluoma, V. Anttila, V. Vainionpaa, J. Hirvonen, P. Ohtonen, A. Mennander, E. Remes, and T. Juvonen Leukocyte filtration improves brain protection after a prolonged period of hypothermic circulatory arrest: A study in a chronic porcine model J. Thorac. Cardiovasc. Surg., December 1, 2000; 120(6): 1131 - 1140. [Abstract] [Full Text] [PDF]
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T.-A. Miyamoto and K.-J. Miyamoto pH-stat strategies protect 60-minute central nervous system ischemia at 29.5{degrees}C Ann. Thorac. Surg., September 1, 2000; 70(3): 1001 - 1002. [Full Text] [PDF]
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V. Anttila, J. Rimpilainen, M. Pokela, K. Kiviluoma, M. Makiranta, V. Jantti, V. Vainionpaa, J. Hirvonen, and T. Juvonen Lamotrigine improves cerebral outcome after hypothermic circulatory arrest: A study in a chronic porcine model J. Thorac. Cardiovasc. Surg., August 1, 2000; 120(2): 247 - 255. [Abstract] [Full Text] [PDF]
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V. Anttila, M. Pokela, K. Kiviluoma, M. Makiranta, J. Hirvonen, and T. Juvonen Is maintained cranial hypothermia the only factor leading to improved outcome after retrograde cerebral perfusion? An experimental study with a chronic porcine model J. Thorac. Cardiovasc. Surg., May 1, 2000; 119(5): 1021 - 1029. [Abstract] [Full Text] [PDF]
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K. M. Dossche, W. J. Morshuis, M. A. Schepens, and F. G. Waanders Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 462 - 467. [Abstract] [Full Text] [PDF]
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M. A. Ergin, S. Uysal, D. L. Reich, A. Apaydin, S. L. Lansman, J. N. McCullough, and R. B. Griepp Temporary neurological dysfunction after deep hypothermic circulatory arrest: a clinical marker of long-term functional deficit Ann. Thorac. Surg., June 1, 1999; 67(6): 1887 - 1890. [Abstract] [Full Text] [PDF]
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