Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery

BackgroundHypothermic circulatory arrest (HCA) in aortic arch surgery has a significant risk of neurological injury despite the newest protective techniques and strategies. Nitric oxide (NO) could exert a protective role, reduce infarct area and increase cerebral perfusion. This study aims to investigate the possible neuroprotective effects of NO administered in the oxygenator of selective antegrade cerebral perfusion (SCP) during HCA.MethodsThirty male SD adult rats (450–550 g) underwent cardiopulmonary bypass (CPB), cooling to 22°C body core temperature followed by 30 min of HCA. Rats were randomized to receive SCP or SCP added with NO (20 ppm) administered through the oxygenator (SCP-NO). All animals underwent CPB-assisted rewarming to a target temperature of 35°C in 60 min. At the end of the experiment, rats were sacrificed, and brain collected. Immunofluorescence analysis was performed in blind conditions.ResultsNeuroinflammation assessed by allograft inflammatory factor 1 or ionized calcium-binding adapter molecule 1 expression, a microglia activation marker was lower in SCP-NO compared to SCP (4.11 ± 0.59 vs. 6.02 ± 0.18%; p < 0.05). Oxidative stress measured by 8oxodG, was reduced in SCP-NO (0.37 ± 0.01 vs. 1.03 ± 0.16%; p < 0.05). Brain hypoxic area extent, analyzed by thiols oxidation was attenuated in SCP-NO (1.85 ± 0.10 vs. 2.74 ± 0.19%; p < 0.05). Furthermore, the apoptotic marker caspases 3 was significantly reduced in SCP-NO (10.64 ± 0.37 vs. 12.61 ± 0.88%; p < 0.05).ConclusionsNitric oxide administration in the oxygenator during SCP and HCA improves neuroprotection by decreasing neuroinflammation, optimizing oxygen delivery by reducing oxidative stress and hypoxic areas, finally decreasing apoptosis.

Download Full-text

Hypothermic circulatory arrest and retrograde cerebral perfusion for aortic arch surgery after dissection: learning from the past, defining the future

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1191578 ◽

2009 ◽

Vol 56 (S 01) ◽

Author(s):

A Karayiannis ◽

T Kiask ◽

G Gotzamanis ◽

BM Kemkes

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Retrograde Cerebral Perfusion ◽

Aortic Arch Surgery ◽

The Past ◽

The Future

Download Full-text

ASSA13-08-16 Aortic Arch Surgery Using Antegrade Selective Cerebral Perfusion in Combination with Cerebral Oximetry

Heart ◽

10.1136/heartjnl-2013-303992.124 ◽

2013 ◽

Vol 99 (Suppl 1) ◽

pp. A41.1-A41

Author(s):

Artem Bakanov ◽

Michael Gordeev ◽

Andrey Bautin

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Cerebral Oximetry ◽

Selective Cerebral Perfusion ◽

Aortic Arch Surgery ◽

Antegrade Selective Cerebral Perfusion

Download Full-text

Aortic Arch Surgery With a Single Centrifugal Pump for Selective Cerebral Perfusion and Systemic Circulation

Artificial Organs ◽

10.1111/j.1525-1594.2009.00892.x ◽

2010 ◽

Vol 34 (1) ◽

pp. E22-E25 ◽

Cited By ~ 2

Author(s):

Keiji Iwata ◽

Yasuhisa Shimazaki ◽

Tomohiko Sakamoto ◽

Hideki Ueda ◽

Masashi Nakagawa ◽

...

Keyword(s):

Aortic Arch ◽

Centrifugal Pump ◽

Cerebral Perfusion ◽

Systemic Circulation ◽

Selective Cerebral Perfusion ◽

Aortic Arch Surgery

Download Full-text

Continuous retrograde cerebral perfusion for protection of the brain during aortic arch surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1016/1010-7940(93)90246-8 ◽

1993 ◽

Vol 7 (11) ◽

pp. 597-600 ◽

Cited By ~ 15

Author(s):

M MURASE ◽

M MAEDA ◽

T KOYAMA ◽

Y TOMIDA ◽

F MURAKAMI ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Retrograde Cerebral Perfusion ◽

Aortic Arch Surgery ◽

The Brain

Download Full-text

Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i3.65 ◽

2019 ◽

Vol 1 (3) ◽

pp. 99-104

Author(s):

Mohamed Abdel Fouly

Keyword(s):

Cerebral Infarction ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Aortic Arch Surgery ◽

Significant Difference ◽

Arch Reconstruction ◽

Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

Download Full-text