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

Jorge D. Salazar, Ryan D. Coleman, Stephen Griffith, Jeffrey D. McNeil, Megan Steigelman, Haven Young, Bart Hensler, Patricia Dixon, John H Calhoon, Faridis Serrano, Robert DiGeronimo

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)162-169
Number of pages8
JournalAnnals of Thoracic Surgery
Volume88
Issue number1
DOIs
StatePublished - Jul 2009

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Deep Hypothermia Induced Circulatory Arrest
Energy Metabolism
Perfusion
Oxygen
Microdialysis
Brain
Cardiopulmonary Bypass
Pyruvic Acid
Lactic Acid
Intracranial Pressure
Glycerol
Brain Injuries
Ischemia
Catheters
Glucose

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Salazar, J. D., Coleman, R. D., Griffith, S., McNeil, J. D., Steigelman, M., Young, H., ... DiGeronimo, R. (2009). Selective Cerebral Perfusion: Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation. Annals of Thoracic Surgery, 88(1), 162-169. https://doi.org/10.1016/j.athoracsur.2009.03.084

Selective Cerebral Perfusion : Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation. / Salazar, Jorge D.; Coleman, Ryan D.; Griffith, Stephen; McNeil, Jeffrey D.; Steigelman, Megan; Young, Haven; Hensler, Bart; Dixon, Patricia; Calhoon, John H; Serrano, Faridis; DiGeronimo, Robert.

In: Annals of Thoracic Surgery, Vol. 88, No. 1, 07.2009, p. 162-169.

Research output: Contribution to journalArticle

Salazar, JD, Coleman, RD, Griffith, S, McNeil, JD, Steigelman, M, Young, H, Hensler, B, Dixon, P, Calhoon, JH, Serrano, F & DiGeronimo, R 2009, 'Selective Cerebral Perfusion: Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation', Annals of Thoracic Surgery, vol. 88, no. 1, pp. 162-169. https://doi.org/10.1016/j.athoracsur.2009.03.084
Salazar, Jorge D. ; Coleman, Ryan D. ; Griffith, Stephen ; McNeil, Jeffrey D. ; Steigelman, Megan ; Young, Haven ; Hensler, Bart ; Dixon, Patricia ; Calhoon, John H ; Serrano, Faridis ; DiGeronimo, Robert. / Selective Cerebral Perfusion : Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 1. pp. 162-169.
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AU - Coleman, Ryan D.

AU - Griffith, Stephen

AU - McNeil, Jeffrey D.

AU - Steigelman, Megan

AU - Young, Haven

AU - Hensler, Bart

AU - Dixon, Patricia

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