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Original Articles: Pediatric Cardiac

Selective Cerebral Perfusion: Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation

^a Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston
^b Department of Neurosurgery, University of Texas Health Science Center, San Antonio
^c Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio
^d Department of Pediatrics, Wilford Hall USAF Medical Center, Lackland AFB, Texas

Accepted for publication March 30, 2009.

^_* Address correspondence to Dr Salazar, Texas Children's Hospital, Division of Congenital Heart Surgery, 6621 Fannin St, WT 19345H, Houston, TX 77030-2399 (Email: jdsalaza{at}texaschildrens.org).

Background: Deep hypothermic circulatory arrest (DHCA) is commonly used for complex cardiac operations in children, often with selective cerebral perfusion (SCP). Little data exist concerning the real-time effects of DHCA with or without SCP on cerebral metabolism. Our objective was to better define these effects, focusing on brain oxygenation and energy metabolism.

Methods: Piglets undergoing cardiopulmonary bypass were assigned to either 60 minutes of DHCA at 18°C (n = 9) or DHCA with SCP at 18°C (n = 8), using pH-stat management. SCP was administered at 10 mL/kg/min. A cerebral microdialysis catheter was implanted into the cortex for monitoring of cellular ischemia and energy stores. Cerebral oxygen tension and intracranial pressure also were monitored. After DHCA with or without SCP, animals were recovered for 4 hours off cardiopulmonary bypass.

Results: With SCP, brain oxygen tension was preserved in contrast to DHCA alone (p < 0.01). Deep hypothermic circulatory arrest was associated with marked elevations of lactate (p < 0.01), glycerol (p < 0.01), and the lactate to pyruvate ratio (p < 0.001), as well as profound depletion of the energy substrates glucose (p < 0.001) and pyruvate (p < 0.001). These changes persisted well into recovery. With SCP, no significant cerebral microdialysis changes were observed. A strong correlation was demonstrated between cerebral oxygen levels and cerebral microdialysis markers (p < 0.001).

Conclusions: Selective cerebral perfusion preserves cerebral oxygenation and attenuates derangements in cerebral metabolism associated with DHCA. Cerebral microdialysis provides real-time metabolic feedback that correlates with changes in brain tissue oxygenation. This model enables further study and refinement of strategies aiming to limit brain injury in children requiring complex cardiac operations.

This article has been cited by other articles:

				J. Salazar, R. Coleman, S. Griffith, J. McNeil, H. Young, J. Calhoon, F. Serrano, and R. DiGeronimo Brain preservation with selective cerebral perfusion for operations requiring circulatory arrest: protection at 25 {degrees}C is similar to 18 {degrees}C with shorter operating times Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 524 - 531. [Abstract] [Full Text] [PDF]