Hypothermic extracorporeal circulation in immature swine

a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest

Hideki Sasaki, Kristine J. Guleserian, Robert Rose, Christos Fotiadis, Philip J. Boyer, Joseph M. Forbess*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Selective antegrade cerebral perfusion (SCP) has been widely used during complex congenital heart surgery and theoretically affords some degree of neuroprotection. There are limited data to support this claim, however. This study was designed to compare, at profound hypothermia, continuous cardiopulmonary bypass, SCP and circulatory arrest in a survival model of extracorporeal circulation in immature swine. Methods: Fifteen piglets (5.9 ± 1.1 kg) were placed on cardiopulmonary bypass (CPB), cooled to a rectal temperature of 15 °C and subjected to 90 min of hypothermic circulatory arrest (HCA), selective cerebral perfusion (30 ml kg-1 min-1) (SCP) or systemic full-flow perfusion (FF; 100 ml kg-1 min-1). Piglets were weaned from CPB and extubated. Daily neurologic assessments were performed for 5 days using neurologic deficit scoring (NDS) and overall performance categories (OPC). On postoperative day (POD) 5, all brains were perfusion-fixed and assigned a total histologic score (THS) of neuronal injury by a neuropathologist blinded to the study groups. Results: The median POD 1 NDS/OPC was 0 (range 0-115)/1(range 1-2) for FF, 130 (range 0-195)/2 (range 1-3) for HCA and 0 (range 0-30)/1 for SCP. Although there was a trend for the neurologic status in the HCA group to be worse on POD 1, this did not achieve significance, and both NDS and OPC scores for HCA animals normalised by POD 5. Median THS was 9 (range, 0-11) for FF, 12 (range, 4-14) for HCA and 9 (range, 0-11) for SCP with no statistically significant difference between the groups. Conclusions: In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.

Original languageEnglish (US)
Pages (from-to)992-997
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume36
Issue number6
DOIs
StatePublished - Dec 1 2009

Fingerprint

Extracorporeal Circulation
Cardiopulmonary Bypass
Swine
Perfusion
Neurologic Manifestations
Brain Injuries
Nervous System
Hypothermia
Thoracic Surgery
Animal Models
Temperature
Wounds and Injuries
Brain

Keywords

  • Cardiopulmonary bypass (CPB)
  • Cerebral protection
  • Hypothermia/circulatory arrest

ASJC Scopus subject areas

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

Cite this

@article{09208766b9f442f0b3e9c10412e1ac3f,
title = "Hypothermic extracorporeal circulation in immature swine: a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest",
abstract = "Objective: Selective antegrade cerebral perfusion (SCP) has been widely used during complex congenital heart surgery and theoretically affords some degree of neuroprotection. There are limited data to support this claim, however. This study was designed to compare, at profound hypothermia, continuous cardiopulmonary bypass, SCP and circulatory arrest in a survival model of extracorporeal circulation in immature swine. Methods: Fifteen piglets (5.9 ± 1.1 kg) were placed on cardiopulmonary bypass (CPB), cooled to a rectal temperature of 15 °C and subjected to 90 min of hypothermic circulatory arrest (HCA), selective cerebral perfusion (30 ml kg-1 min-1) (SCP) or systemic full-flow perfusion (FF; 100 ml kg-1 min-1). Piglets were weaned from CPB and extubated. Daily neurologic assessments were performed for 5 days using neurologic deficit scoring (NDS) and overall performance categories (OPC). On postoperative day (POD) 5, all brains were perfusion-fixed and assigned a total histologic score (THS) of neuronal injury by a neuropathologist blinded to the study groups. Results: The median POD 1 NDS/OPC was 0 (range 0-115)/1(range 1-2) for FF, 130 (range 0-195)/2 (range 1-3) for HCA and 0 (range 0-30)/1 for SCP. Although there was a trend for the neurologic status in the HCA group to be worse on POD 1, this did not achieve significance, and both NDS and OPC scores for HCA animals normalised by POD 5. Median THS was 9 (range, 0-11) for FF, 12 (range, 4-14) for HCA and 9 (range, 0-11) for SCP with no statistically significant difference between the groups. Conclusions: In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.",
keywords = "Cardiopulmonary bypass (CPB), Cerebral protection, Hypothermia/circulatory arrest",
author = "Hideki Sasaki and Guleserian, {Kristine J.} and Robert Rose and Christos Fotiadis and Boyer, {Philip J.} and Forbess, {Joseph M.}",
year = "2009",
month = "12",
day = "1",
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Hypothermic extracorporeal circulation in immature swine : a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest. / Sasaki, Hideki; Guleserian, Kristine J.; Rose, Robert; Fotiadis, Christos; Boyer, Philip J.; Forbess, Joseph M.

In: European Journal of Cardio-thoracic Surgery, Vol. 36, No. 6, 01.12.2009, p. 992-997.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hypothermic extracorporeal circulation in immature swine

T2 - a comparison of continuous cardiopulmonary bypass, selective antegrade cerebral perfusion and circulatory arrest

AU - Sasaki, Hideki

AU - Guleserian, Kristine J.

AU - Rose, Robert

AU - Fotiadis, Christos

AU - Boyer, Philip J.

AU - Forbess, Joseph M.

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Objective: Selective antegrade cerebral perfusion (SCP) has been widely used during complex congenital heart surgery and theoretically affords some degree of neuroprotection. There are limited data to support this claim, however. This study was designed to compare, at profound hypothermia, continuous cardiopulmonary bypass, SCP and circulatory arrest in a survival model of extracorporeal circulation in immature swine. Methods: Fifteen piglets (5.9 ± 1.1 kg) were placed on cardiopulmonary bypass (CPB), cooled to a rectal temperature of 15 °C and subjected to 90 min of hypothermic circulatory arrest (HCA), selective cerebral perfusion (30 ml kg-1 min-1) (SCP) or systemic full-flow perfusion (FF; 100 ml kg-1 min-1). Piglets were weaned from CPB and extubated. Daily neurologic assessments were performed for 5 days using neurologic deficit scoring (NDS) and overall performance categories (OPC). On postoperative day (POD) 5, all brains were perfusion-fixed and assigned a total histologic score (THS) of neuronal injury by a neuropathologist blinded to the study groups. Results: The median POD 1 NDS/OPC was 0 (range 0-115)/1(range 1-2) for FF, 130 (range 0-195)/2 (range 1-3) for HCA and 0 (range 0-30)/1 for SCP. Although there was a trend for the neurologic status in the HCA group to be worse on POD 1, this did not achieve significance, and both NDS and OPC scores for HCA animals normalised by POD 5. Median THS was 9 (range, 0-11) for FF, 12 (range, 4-14) for HCA and 9 (range, 0-11) for SCP with no statistically significant difference between the groups. Conclusions: In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.

AB - Objective: Selective antegrade cerebral perfusion (SCP) has been widely used during complex congenital heart surgery and theoretically affords some degree of neuroprotection. There are limited data to support this claim, however. This study was designed to compare, at profound hypothermia, continuous cardiopulmonary bypass, SCP and circulatory arrest in a survival model of extracorporeal circulation in immature swine. Methods: Fifteen piglets (5.9 ± 1.1 kg) were placed on cardiopulmonary bypass (CPB), cooled to a rectal temperature of 15 °C and subjected to 90 min of hypothermic circulatory arrest (HCA), selective cerebral perfusion (30 ml kg-1 min-1) (SCP) or systemic full-flow perfusion (FF; 100 ml kg-1 min-1). Piglets were weaned from CPB and extubated. Daily neurologic assessments were performed for 5 days using neurologic deficit scoring (NDS) and overall performance categories (OPC). On postoperative day (POD) 5, all brains were perfusion-fixed and assigned a total histologic score (THS) of neuronal injury by a neuropathologist blinded to the study groups. Results: The median POD 1 NDS/OPC was 0 (range 0-115)/1(range 1-2) for FF, 130 (range 0-195)/2 (range 1-3) for HCA and 0 (range 0-30)/1 for SCP. Although there was a trend for the neurologic status in the HCA group to be worse on POD 1, this did not achieve significance, and both NDS and OPC scores for HCA animals normalised by POD 5. Median THS was 9 (range, 0-11) for FF, 12 (range, 4-14) for HCA and 9 (range, 0-11) for SCP with no statistically significant difference between the groups. Conclusions: In this survival model of hypothermic extracorporeal circulatory support in immature swine, histologic brain injury was similar in piglets subjected to FF, SCP or HCA. Although the HCA group tended to have worse early neurologic outcome, any difference clearly disappeared by POD 5. These data raise the possibility that profound hypothermia alone during extracorporeal support may produce this observed brain injury. Additional study is required to define the precise aetiology of the brain injury observed in this animal model.

KW - Cardiopulmonary bypass (CPB)

KW - Cerebral protection

KW - Hypothermia/circulatory arrest

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JO - European Journal of Cardio-thoracic Surgery

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