Ann Thorac Surg 2005;80:1467
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Markus K. Heinemann, MD, PhD
Pediatric Cardiac Surgery, Mainz University Hospital, Langenbeckstr 1, 505, Mainz, D-55131 Germany
(Email: heinemann{at}uni-mainz.de).
In this very elaborate study [1], the group from Boston Children's Hospital has once again focused on the effects of cardiopulmonary bypass on brain perfusion.
Manipulation of both temperature and flow confirmed that the so-called safe pump flow rate is highly dependent on the conditions of the environment, with temperature playing a vital role. The effectiveness of the two monitoring methods, intravital microscopy and near-infrared spectroscopy (NIRS), was evaluated by careful neuropathologic examination. The authors feel confident enough to recommend NIRS for real-time monitoring in clinical practice. In essence, the results of this study proved one more time that coldness remains the principal mode of cerebral (and other organ) protection. This remains interesting information, especially in an era in which more and more attempts are made to move away from low CPB temperatures for various reasons.
Pediatric cardiac surgery in the 21st century has reached a state of perfection that allows anatomical or at least functional correction of even the most complex congenital heart disease. The time has come to take our attention way beyond the cardiac visual field and to reflect what we are really doing. Sophisticated articles after meticulously performed experiments such as the one by Anttila and co-workers help to expand our knowledge and understanding of fascinating biologic interrelationships. Many questions still remain unanswered, forming the incentive and the challenge to continue with research of this kind.
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- Anttila V, Hagino I, Zurakowski D, et al. Specific bypass conditions determine safe minimum flow rate Ann Thorac Surg 2005;80:1460-1467.[Abstract/Free Full Text]
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