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Brain preservation with selective cerebral perfusion for operations requiring circulatory arrest: protection at 25 °C is similar to 18 °C with shorter operating times

Brain preservation with selective cerebral perfusion for operations requiring circulatory arrest: protection at 25 °C is similar to 18 °C with shorter

Brain preservation with selective cerebral perfusion for operations requiring circulatory arrest: protection at 25 °C is similar to 18 °C with shorter operating times   (Citations: 2)
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Background: Hypothermic circulatory arrest (HCA) is employed for aortic arch and other complex operations, often with selective cerebral perfusion (SCP). Our previous work has demonstrated real-time evidence of improved brain protection using SCP at 18°C. The purpose of this study was to evaluate the utility of SCP at warmer temperatures (25°C) and its impact on operating times. Methods: Piglets undergoing cardiopulmonary bypass (CPB) and 60min of HCA were assigned to three groups: 18°C without SCP, 18°C with SCP and 25°C with SCP (n=8 animals per group). CPB flows were 100mlkg−1min−1 using pH-stat management. SCP flows were 10mlkg−1min−1 via the innominate artery. Cerebral oxygenation was monitored using NIRS (near-infrared spectroscopy). A microdialysis probe placed into the cerebral cortex had samples collected every 15min. Animals were recovered for 4h after separation from CPB. All data are presented as mean±standard deviation (SD; p<0.05, significant). Results: Cerebral oxygenation was preserved during deep and tepid HCA with SCP, in contrast to deep HCA without SCP (p<0.05). Deep HCA at 18°C without SCP resulted in significantly elevated brain lactate (p<0.01) and glycerol (p<0.01), while the energy substrates glucose (p<0.001) and pyruvate (p<0.001) were significantly depleted. These derangements were prevented with SCP at 18°C and 25°C. The lactate/pyruvate ratio (L/P) was profoundly elevated following HCA alone (p<0.001) and remained persistently elevated throughout recovery (p<0.05). Piglets given SCP during HCA at 18°C and 25°C maintained baseline L/P ratios. Mean operating times were significantly shorter in the 25°C group compared to both 18°C groups (p<0.05) without evidence of significant acidemia. Conclusion: HCA results in cerebral hypoxia, energy depletion and ischaemic injury, which are attenuated with the use of SCP at both 18°C and 25°C. Procedures performed at 25°C had significantly shorter operating times while preserving end organs.
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