Cerebral protection during moderate hypothermic circulatory arrest: Histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs

C. L. Filgueiras, L. Ryner, J. Ye, L. Yang, M. Ede, J. Sun, P. Kozlowski, R. Summers, J. K. Saunders, Tomas Salerno, R. Deslauriers

Research output: Contribution to journalArticle

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Abstract

Objective: We evaluated the effect of antegrade and retrograde brain perfusion during moderate hypothermic circulatory arrest at 28° C. Methods: Phosphorus 31-magnetic resonance spectroscopy was used to follow brain energy metabolites and intracellular pH in pigs during 2 hours of ischemia and 1 hour of reperfusion. Histopathologic analysis of brain tissue fixed at the end of the experimental protocol was performed. Fourteen pigs were divided into two experimental groups subjected to antegrade (n = 6) or retrograde (n = 8) brain perfusion. Anesthesia (n = 8) and hypothermic cardiopulmonary bypass groups (15° C, n = 8) served as control subjects. In the antegrade and retrograde brain perfusion groups, the initial bypass flow rate was 60 to 100 ml · kg-1 · min-1. In the antegrade group, the brain was perfused through the carotid arteries at a flow rate of 180 to 210 ml · min-1 during circulatory arrest at 28° C. In the retrograde group, the brain was perfused through the superior vena cava at a flow rate of 300 to 500 ml · min-1 during circulatory arrest at 28° C. Results: The intracellular pH was 7.1 ± 0.1 and 7.2 ± 0.1 in the anesthesia and hypothermic bypass groups, respectively. Brain intracellular pH and high-energy metabolites (adenosine triphosphate, phosphocreatine) did not change during the course of the 3.5-hour study. In the antegrade group, adenosine triphosphate and intracellular pH were unchanged throughout the protocol. In the retrograde perfusion group, the intracellular pH level decreased to 6.4 ± 0.1, and adenosine triphosphate and phosphocreatine levels decreased within the first 30 minutes of circulatory arrest and remained at low levels until the end of reperfusion. High-energy phosphates did not return to their initial levels during reperfusion. Histopathologic analysis of nine regions of the brain showed good preservation of cell structure in the anesthesia, hypothermic bypass, and antegrade perfusion groups. The retrograde perfusion group showed changes in all the regions examined. Conclusions: The study shows that moderate hypothermic circulatory arrest at 28° C with antegrade brain perfusion during circulatory arrest protects the brain but that retrograde cerebral perfusion at 28° C dues not protocol the brain.

Original languageEnglish
Pages (from-to)1073-1080
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume112
Issue number4
DOIs
StatePublished - Oct 21 1996
Externally publishedYes

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Magnetic Resonance Spectroscopy
Swine
Brain
Perfusion
Reperfusion
Phosphocreatine
Anesthesia
Adenosine Triphosphate
Superior Vena Cava
Cardiopulmonary Bypass
Carotid Arteries
Phosphorus
Ischemia
Phosphates

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cerebral protection during moderate hypothermic circulatory arrest : Histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs. / Filgueiras, C. L.; Ryner, L.; Ye, J.; Yang, L.; Ede, M.; Sun, J.; Kozlowski, P.; Summers, R.; Saunders, J. K.; Salerno, Tomas; Deslauriers, R.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 112, No. 4, 21.10.1996, p. 1073-1080.

Research output: Contribution to journalArticle

Filgueiras, C. L. ; Ryner, L. ; Ye, J. ; Yang, L. ; Ede, M. ; Sun, J. ; Kozlowski, P. ; Summers, R. ; Saunders, J. K. ; Salerno, Tomas ; Deslauriers, R. / Cerebral protection during moderate hypothermic circulatory arrest : Histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs. In: Journal of Thoracic and Cardiovascular Surgery. 1996 ; Vol. 112, No. 4. pp. 1073-1080.
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T2 - Histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs

AU - Filgueiras, C. L.

AU - Ryner, L.

AU - Ye, J.

AU - Yang, L.

AU - Ede, M.

AU - Sun, J.

AU - Kozlowski, P.

AU - Summers, R.

AU - Saunders, J. K.

AU - Salerno, Tomas

AU - Deslauriers, R.

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N2 - Objective: We evaluated the effect of antegrade and retrograde brain perfusion during moderate hypothermic circulatory arrest at 28° C. Methods: Phosphorus 31-magnetic resonance spectroscopy was used to follow brain energy metabolites and intracellular pH in pigs during 2 hours of ischemia and 1 hour of reperfusion. Histopathologic analysis of brain tissue fixed at the end of the experimental protocol was performed. Fourteen pigs were divided into two experimental groups subjected to antegrade (n = 6) or retrograde (n = 8) brain perfusion. Anesthesia (n = 8) and hypothermic cardiopulmonary bypass groups (15° C, n = 8) served as control subjects. In the antegrade and retrograde brain perfusion groups, the initial bypass flow rate was 60 to 100 ml · kg-1 · min-1. In the antegrade group, the brain was perfused through the carotid arteries at a flow rate of 180 to 210 ml · min-1 during circulatory arrest at 28° C. In the retrograde group, the brain was perfused through the superior vena cava at a flow rate of 300 to 500 ml · min-1 during circulatory arrest at 28° C. Results: The intracellular pH was 7.1 ± 0.1 and 7.2 ± 0.1 in the anesthesia and hypothermic bypass groups, respectively. Brain intracellular pH and high-energy metabolites (adenosine triphosphate, phosphocreatine) did not change during the course of the 3.5-hour study. In the antegrade group, adenosine triphosphate and intracellular pH were unchanged throughout the protocol. In the retrograde perfusion group, the intracellular pH level decreased to 6.4 ± 0.1, and adenosine triphosphate and phosphocreatine levels decreased within the first 30 minutes of circulatory arrest and remained at low levels until the end of reperfusion. High-energy phosphates did not return to their initial levels during reperfusion. Histopathologic analysis of nine regions of the brain showed good preservation of cell structure in the anesthesia, hypothermic bypass, and antegrade perfusion groups. The retrograde perfusion group showed changes in all the regions examined. Conclusions: The study shows that moderate hypothermic circulatory arrest at 28° C with antegrade brain perfusion during circulatory arrest protects the brain but that retrograde cerebral perfusion at 28° C dues not protocol the brain.

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