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Right arrow Extracorporeal circulation

Ann Thorac Surg 2005;80:1955-1964
© 2005 The Society of Thoracic Surgeons

Review

Neonatal Brain Protection and Deep Hypothermic Circulatory Arrest: Pathophysiology of Ischemic Neuronal Injury and Protective Strategies

Gabriel Amir, MD a , * , Chandra Ramamoorthy, MD b , R. Kirk Riemer, PhD a , V. Mohan Reddy, MD a , Frank L. Hanley, MD a

a Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
b Department of Anesthesiology, Stanford University School of Medicine, Stanford, California

* Address correspondence to Dr Amir, Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA94305 (Email: gabiamir{at}stanford.edu).

Deep hypothermic circulatory arrest (DHCA) has been used for the past 50 years in the surgical repair of complex congenital cardiac malformations and operations involving the aortic arch; it enables the surgeon to achieve precise anatomical reconstructions by creating a bloodless operative field. Nevertheless, DHCA has been associated with immediate and late neurodevelopmental morbidities. This review provides an overview of the pathophysiology of neonatal hypoxic brain injury after DHCA, focusing on cellular mechanisms of necrosis, apoptosis, and glutamate excitotoxicity. Techniques and strategies in neonatal brain protection include hypothermia, acid base blood gas management during cooling, and pharmacologic interventions such as the use of volatile anesthetics. Surgical techniques consist of intermittent cerebral perfusion during periods of circulatory arrest and continuous regional brain perfusion.




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