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Ann Thorac Surg 1997;64:1088
© 1997 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Julie A. Swain, MD

See also page 1082.

As cardiac surgeons and scientists, we have concentrated on developing mechanical methods to afford neuroprotection during deep hypothermic circulatory arrest. These have included antegrade and retrograde cerebral perfusion, packing the head in ice, variation in perfusion flow, pulsatile perfusion, and dealing with the atherosclerotic aorta. Pharmacologic interventions generally have focused on decreasing cerebral oxygen consumption by anesthetics and barbiturates and the prevention of hyperglycemia.

This laboratory investigation by Bokesch and colleagues demonstrates the successful application of molecular biology to the design of a pharmacologic strategy of brain protection in circulatory arrest patients. Their pioneering work in describing protooncogene expression and the time course of translational/transcriptional changes after different periods of circulatory arrest represents a very significant step forward in our understanding of, and options for, pharmacologic pretreatment strategies in our patients.


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Immediate-Early Gene Expression in Ovine Brain After Hypothermic Circulatory Arrest: Effects of Aptiganel
Paula M. Bokesch, Dermot P. Halpin, William R. Ranger, Jonathan J. Drummond-Webb, James E. Marchand, Roderick T. Bronson, Kenneth G. Warner, and Richard M. Kream
Ann. Thorac. Surg. 1997 64: 1082-1088. [Abstract] [Full Text]




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