Retrograde Cerebral Perfusion with Hypothermic Blood Provides Efficient Protection of the Brain: A Neuropathological Study

The aim of this study was to determine whether alpha- or pH-stat protects the brain during deep hypothermic retrograde cerebral perfusion. Fifteen anesthetized dogs on cardiopulmonary bypass were cooled to 18°C under alpha-stat and underwent retrograde cerebral perfusion for 90 minutes under alpha-stat or pH-stat, or underwent antegrade cardiopulmonary bypass under alpha-stat as the control. Cerebral blood flow of the cortex was monitored and serial analyses of blood gases and total nitric oxide oxidation products made. Cerebral blood flow and cerebral metabolic rate for oxygen were significantly higher and plasma levels of nitric oxide oxidation products in the outflow from the brain were significantly lower in retrograde cerebral perfusion under pH-stat than under alpha-stat. This study shows that reduced levels of nitric oxide oxidation products may protect against neuronal damage induced by nitric oxide and that increased cerebral blood flow under pH-stat may lead to a reduction of nitric oxide oxidation products. Under retrograde cerebral perfusion, pH-stat is thus better than alpha-stat for protecting the brain.

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Protection of the brain by retrograde cerebral perfusion during circulatory arrest

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(94)70198-9 ◽

1994 ◽

Vol 108 (5) ◽

pp. 969-974 ◽

Cited By ~ 31

Author(s):

Pyng Jing Lin ◽

Chau-Hsiung Chang ◽

Peter P.C. Tan ◽

Chun-Chieh Wang ◽

Jen-Ping Chang ◽

...

Keyword(s):

Cerebral Perfusion ◽

Circulatory Arrest ◽

Retrograde Cerebral Perfusion ◽

The Brain

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The effect of retrograde cerebral perfusion after particulate embolization to the brain

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(95)70070-6 ◽

1995 ◽

Vol 110 (5) ◽

pp. 1470-1485 ◽

Cited By ~ 39

Author(s):

M.Enver Yerlioglu ◽

David Wolfe ◽

Craig K. Mezrow ◽

Donald J. Weisz ◽

Peter S. Midulla ◽

...

Keyword(s):

Cerebral Perfusion ◽

Retrograde Cerebral Perfusion ◽

The Brain

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Increased pressure during retrograde cerebral perfusion provides better preservation of the Na+, K+-ATPase activity

Perfusion ◽

10.1177/0267659106073993 ◽

2006 ◽

Vol 21 (6) ◽

pp. 319-324 ◽

Cited By ~ 1

Author(s):

Luojia Yang ◽

Zhijun Li ◽

Yanmin Yang ◽

Raymound Zhu ◽

Randy Summers ◽

...

Keyword(s):

High Pressure ◽

Atpase Activity ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Low Pressure ◽

Control Group ◽

Pressure Group ◽

Retrograde Cerebral Perfusion ◽

Significant Impairment ◽

The Brain

This study was carried out to determine if increased perfusion pressure during retrograde cerebral perfusion (RCP) provides better preservation of the brain Na+, K+-ATPase activity. Twenty pigs were subjected to anesthesia alone (control group, n =5), hypothermic circulatory arrest (HCA) (HCA group, n =5), HCA+RCP at perfusion pressures of 24-29 mmHg (Low-pressure group, n= 5), or HCA+RCP at perfusion pressures of 34-40 mmHg (High-pressure group, n =5). The brain was harvested for the measurement of tissue Na+, K+-ATPase activity. Relative to the control pigs (67.29∓2.1%), significant impairment of Na+, K+-ATPase activity was observed in all three experimental groups (29.89∓7.4% in HCA group, 33.59∓2.9% in the Low-pressure group, and 52.09∓1.8% in the High-pressure group, p <0.01). The best preservation of the enzyme, particularly in the cortex and cerebellum regions, was observed in the High-pressure group (p <0.01). In conclusion, HCA causes severe impairment of Na+, K+-ATPase activity, and increasing perfusion pressures from 24 +29 to 34 +40 mmHg during RCP significantly improves preservation of Na+, K+-ATPase activity, and the improvement of the protection varies in different regions of the brain.

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