scholarly journals Visual light spectroscopy reflects flow-related changes in brain oxygenation during regional low-flow perfusion and deep hypothermic circulatory arrest

2006 ◽  
Vol 132 (6) ◽  
pp. 1307-1312 ◽  
Author(s):  
Gabriel Amir ◽  
Chandra Ramamoorthy ◽  
R. Kirk Riemer ◽  
Corrine R. Davis ◽  
Frank L. Hanley ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Low Flow ◽  
Brain Oxygenation ◽  
Flow Perfusion ◽  
Visual Light

Laboratory studies regarding regional low-flow perfusion for neonatal cardiac surgery

2005 ◽  
Vol 15 (S1) ◽  
pp. 134-141 ◽  
Author(s):  
William M. DeCampli
Keyword(s):  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Low Flow ◽  
Flow Perfusion ◽  
Neonatal Cardiac Surgery ◽  
The Central Nervous System ◽  
And Performance ◽  
Performance Intelligence Quotient

As the overall mortality declines following repair of complex congenital cardiac malformations, attention has focused on reducing the lasting morbidity of these interventions, particularly the observed neurodevelopmental deficiencies. Both cardiopulmonary bypass and deep hypothermic circulatory arrest produce transient alterations in cerebral hemodynamics and metabolism. In studies performed in animals, deep hypothermic circulatory arrest, as compared to cardiopulmonary bypass alone, has been shown to produce excess injury to, and death of, neuronal and glial cells.1 In neonates, deep hypothermic circulatory arrest of greater duration than one hour is a risk factor for early post-operative seizures, and for subsequent neurodevelopmental deficits.2 The Boston Circulatory Arrest Study suggests that, at follow-up of eight years, infants subjected to greater than 41 minutes of deep hypothermic circulatory arrest had excess deficits in full-scale, verbal and performance intelligence quotient, the Mayo apraxia test, and grooved pegboard testing.3 The independent adverse effects of deep hypothermic circulatory arrest have encouraged clinicians to develop the alternative technique of intermittent global perfusion, or continuous regional perfusion at low flow perfusion, in an attempt to reduce the degree of injury to the central nervous system.4–7

Cerebral Oxygenation during Pediatric Cardiac Surgery Using Deep Hypothermic Circulatory Arrest 

1995 ◽  
Vol 82 (1) ◽  
pp. 74-82 ◽  
Author(s):  
Dean C. Kurth ◽  
James M. Steven ◽  
Susan C. Nicolson
Keyword(s):  
Cardiac Surgery ◽  
Half Life ◽  
Cerebral Oxygenation ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Pediatric Cardiac Surgery ◽  
Brain Oxygenation ◽  
Neurologic Status ◽  
Cerebral Dysfunction

Background Deep hypothermic circulatory arrest is a widely used technique in pediatric cardiac surgery that carries a risk of neurologic injury. Previous work in neonates identified distinct changes in cerebral oxygenation during surgery. This study sought to determine whether the intraoperative changes in cerebral oxygenation vary between neonates, infants, and children and whether the oxygenation changes are associated with postoperative cerebral dysfunction. Methods The study included eight neonates, ten infants, and eight children without preexisting neurologic disease. Cerebrovascular hemoglobin oxygen saturation (SCO2), an index of brain oxygenation, was monitored intraoperatively by near-infrared spectroscopy. Body temperature was reduced to 15 degrees C during cardiopulmonary bypass (CPB) before commencing circulatory arrest. Postoperative neurologic status was judged as normal or abnormal (seizures, stroke, coma). Results Relative to preoperative levels, the age groups experienced similar changes in SCO2 during surgery: SCO2 increased 30 +/- 4% during deep hypothermic CPB, it decreased 62 +/- 5% by the end of arrest, and it increased 20 +/- 5% during CPB recirculation (all P < 0.001); after rewarming and removal of CPB, SCO2 returned to preoperative levels. During arrest, the half-life of SCO2 was 9 +/- 1 min in neonates, 6 +/- 1 min in infants, and 4 +/- 1 min in children (P < 0.001). Postoperative neurologic status was abnormal in three (12%) patients. The SCO2 increase during deep hypothermic CPB was less in these patients than in the remaining study population (3 +/- 2% versus 33 +/- 4%, P < 0.001). There were no other significant SCO2 differences between outcome groups. Conclusions Brain oxygenation changed at distinct points during surgery in all ages, reflecting fundamental cerebral responses to hypothermic CPB, ischemia, and reperfusion. However, the changes in SCO2 half-life with age reflect developmental differences in the rate of cerebral oxygen utilization during arrest, consistent with experimental work in animals. Certain intraoperative cerebral oxygenation patterns may be associated with postoperative cerebral dysfunction and require further study.

Antegrade regional cerebral perfusion

2004 ◽  
Vol 14 (S1) ◽  
pp. 70-74 ◽  
Author(s):  
Christo I. Tchervenkov ◽  
Abdulaziz Al-Khaldi ◽  
Dominique Shum-Tim
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
General Trend ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Low Flow ◽  
Norwood Operation ◽  
Flow Perfusion ◽  
Bloodless Field ◽  
Surgical Conditions

A quiet and bloodless field providing optimal surgical conditions has been a crucial prerequisite for the performance of complex cardiac repairs in early life. The use of deep hypothermic circulatory arrest has fulfilled this role, and has been a catalyst for the development of neonatal and infant cardiac surgery. The recently increased awareness of possibly increased incidence of adverse neurological events and developmental outcome associated with this technique,1–5however, has led to a general trend away from its use. In its place, techniques have been developed to provide cerebral perfusion during reconstruction of the aortic arch and the Norwood operation. Some have described the techniques as regional low-flow perfusion. In our opinion, they are described more accurately as antegrade regional cerebral perfusion. In this review, we discuss the recently described techniques for such antegrade regional cerebral perfusion during surgery on the aortic arch, with emphasis both on the Norwood operation and the observed physiological changes in the cerebral and systemic circulations. The neurologic and developmental outcomes following the use of the technique are still unknown.

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