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Ann Thorac Surg 2004;77:1664-1670
© 2004 The Society of Thoracic Surgeons
a Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
b Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
c Department of Physiology, University of Manitoba, Winnipeg, Manitoba, Canada
d Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, Manitoba, Canada
Accepted for publication October 2, 2003.
* Address reprint requests to Dr Ye, Biosystems, Institute for Biodiagnostics/NRC, 435 Ellice Ave, Winnipeg, ManitobaR3B 1Y6, Canada
e-mail: jian.ye{at}nrc-cnrc.gc.ca
BACKGROUND: Although it is well documented that the use of a pH-stat strategy during hypothermic cardiopulmonary bypass improves cerebral blood flow, an 
-stat strategy has been almost exclusively used during retrograde cerebral perfusion. We investigated the effects of pH-stat and -stat management on brain tissue blood flow and oxygenation during retrograde cerebral perfusion in a porcine model to determine if the use of a pH-stat strategy during retrograde cerebral perfusion improves brain tissue perfusion.
METHODS: Fourteen pigs were managed by an -stat strategy (alpha-stat group, n = 7) or by a pH-stat strategy (pH-stat group, n = 7) during 120 minutes of hypothermic retrograde cerebral perfusion. Retrograde cerebral perfusion was established through the superior vena cava. Brain tissue blood flow and oxygenation were measured continuously with a laser flowmeter and near infrared spectroscopy, respectively. Brain tissue water content was determined at the end of the experiments.
RESULTS: During cooling, brain tissue blood flow was significantly higher with use of the pH-stat strategy than with the -stat strategy (86% ± 10% versus 40% ± 3% of baseline). During retrograde cerebral perfusion, brain tissue blood flow was also significantly higher (about three times higher) in the pH-stat group than in the alpha-stat group (15% ± 4% versus 5% ± 1% of baseline at 60 minutes of retrograde cerebral perfusion). Tissue oxygen saturation appeared to be higher during retrograde cerebral perfusion in the pH-stat group than in the alpha-stat group. Brain tissue blood flow during rewarming remained significantly higher with the use of pH-stat than with the use of -stat. Brain tissue water contents were similar in both groups.
CONCLUSIONS: In our pig model, the use of a pH-stat strategy during retrograde cerebral perfusion significantly improves brain tissue perfusion. Therefore, to improve retrograde cerebral blood flow during retrograde cerebral perfusion, it may be preferable to use a pH-stat strategy, rather than an -stat strategy.
This article has been cited by other articles:
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  Y. Yang, Z. Li, L. Yang, M. Jackson, A. Turner, and J. Ye Effect of pH Management on Brain Perfusion During Retrograde Cerebral Perfusion Asian Cardiovasc Thorac Ann, December 1, 2006; 14(6): 495 - 500. [Abstract] [Full Text] [PDF]
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 L. Yang, Z. Li, Y. Yang, R. Zhu, R. Summers, R. Deslauriers, and J. Ye Increased pressure during retrograde cerebral perfusion provides better preservation of the Na+, K+-ATPase activity Perfusion, November 1, 2006; 21(6): 319 - 324. [Abstract] [PDF]
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 S. Dahlbacka, J. Heikkinen, T. Kaakinen, P. Laurila, V. Vainionpaa, K. Kiviluoma, T. Salomaki, H. Tuominen, P. Ohtonen, F. Biancari, et al. pH-Stat Versus {alpha}-Stat Acid-Base Management Strategy During Hypothermic Circulatory Arrest Combined With Embolic Brain Injury Ann. Thorac. Surg., April 1, 2005; 79(4): 1316 - 1325. [Abstract] [Full Text] [PDF]
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