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Ann Thorac Surg 2007;83:895-901
© 2007 The Society of Thoracic Surgeons

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Hawley H. Seiler Resident Award Paper

The Use of a Miniaturized Circuit and Bloodless Prime To Avoid Cerebral No-Reflow After Neonatal Cardiopulmonary Bypass

^a Oregon Health and Sciences University, Portland, Oregon
^b Hospital for Sick Children, Toronto, Ontario, Canada

Accepted for publication October 16, 2006.

^_* Address correspondence to Dr Hickey, CHSS Data Center 555 University Ave, Toronto, Ontario M5G 1X8, Canada (Email: edward.hickey{at}sickkids.ca).

Presented at the Basic Science Forum of the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

Background: Our miniaturized bloodless prime circuit for neonatal cardiopulmonary bypass (CPB) has previously been shown to elicit significantly reduced systemic inflammation. We studied the effects of this circuit on cerebral reperfusion because the pathophysiology of "no-reflow" is believed to have an inflammatory component.

Methods: Twenty neonatal piglets were randomized to CPB with miniaturized circuitry using either blood (group 1) or bloodless (group 2) prime. At 18°C, piglets underwent 60 minutes of either (A) deep hypothermic circulatory arrest (DHCA) or (B) continuous low-flow bypass (DHCLF). Analysis of cerebral blood flow (CBF) was undertaken before and after CPB in addition to quantification of circulating tumor necrosis factor- (TNF) and intracerebral TNF messenger RNA (mRNA).

Results: The final hematocrit in group 2 was 22% versus 28% (p < 0.05). The CBF fell in every animal in group 1A, but increased in every animal in group 2A (p < 0.001), despite no overall change in total cardiac output. The use of DHCLF was not associated with pronounced trends in either prime group. Final serum TNF concentrations were significantly higher in group 1B (3166 ± 843 pg/mL) than group 2B (439 ± 192 pg/mL; p < 0.05). Irrespective of the CPB strategy used, the use of a blood prime generated significantly higher levels of intracerebral TNF mRNA.

Conclusions: We attribute the hyperemic cerebrovascular response to reduced inflammation through avoiding allogeneic whole blood. The analysis of circulating and intracerebral TNF in this study suggests that DHCLF in conjunction with a bloodless prime might offer advantages through avoiding ischemia, no-reflow, and in addition, resulting in a significantly reduced cerebral inflammatory response.

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