Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection?

Khaladj, Nawid; Peterss, Sven; Oetjen, Pitt; von Wasielewski, Reinhard; Hauschild, Gregor; Karck, Matthias; Haverich, Axel; Hagl, Christian
September 2006
European Journal of Cardio-Thoracic Surgery;Sep2006, Vol. 30 Issue 3, p492
Academic Journal
Abstract: Objective: Selective antegrade cerebral perfusion (SACP) seems to be associated with a better outcome compared to hypothermic circulatory arrest (HCA) alone. This study was undertaken to evaluate the influence of different SACP temperatures on the neurological integrity. Methods: Twenty-six pigs were included in the study and assigned to 100min HCA at 20°C body temperature without (n =6) or with either 10°C (n =6), 20°C (n =7) or 30°C (n =7) of SACP. Haemodynamics, metabolics and neurophysiology (EEG, SSEP, ICP, sagittal sinus saturation) were monitored. Animals were sacrified 4h after reperfusion and brains perfused for histological and molecular genetic assessment. Results: There were no clinically relevant differences in haemodynamics between groups. The rise in ICP during SACP was significantly more marked in the 30°C group (p <0.05) and remained high during the entire experiment. In the 10°C group the rise in ICP was postponed, but increased during reperfusion. The 20°C group showed a slight increase of ICP over time, but remained significantly lower compared to HCA (p <0.05). Sagittal sinus saturation decreased during SACP at 30°C (p <0.05). EEG recovery was most complete in the 20°C group (p <0.05). RT-PCR analysis of brain tissue revealed a reduction for heat shock protein (HSP-72) in 20°C (p <0.05) and 10°C animals (p =0.095). Histopathological evaluation showed a reduction of edema and eosinophilic cells in the groups treated with SACP. Conclusion: In this model, SACP is superior to HCA alone. Regarding the optimal temperature for SACP, it seems that 20°C provides adequate brain protection in comparison to the potential detrimental effects of moderate (30°C) and profound (10°C) temperatures.


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