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Neuroprotective effect of selective antegrade cerebral perfusion during prolonged deep hypothermic circulatory arrest: Cerebral metabolism evidence in a pig model [Anatol J Cardiol]
Anatol J Cardiol. 2018; 19(1): 2-10 | DOI: 10.14744/AnatolJCardiol.2017.7946  

Neuroprotective effect of selective antegrade cerebral perfusion during prolonged deep hypothermic circulatory arrest: Cerebral metabolism evidence in a pig model

Zhixian Tang1, Mengya Liang2, Guangxian Chen2, Jian Rong3, Jianping Yao2, Zhen Chen3, Xiao Yang2, Zhongkai Wu2
1Department of Cardiothoracic Surgery, The First Affiliated Hospital of Gannan Medical University; Ganzhou-China
2Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou-China
3Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou-China

Objective: The aim of this study was to elucidate the mechanism of cerebral injury and to evaluate selective antegrade cerebral perfusion (SACP) as a superior neuroprotective strategy for prolonged deep hypothermic circulatory arrest (DHCA).
Methods: Twelve pigs (68-week old) were randomly assigned to DHCA alone (n=6) and DHCA with SACP (n=6) at 18C for 80 min groups. Serum S100 was determined using an immunoassay analyzer. The concentrations of cerebral dialysate glucose, lactate, pyruvate, glycerol, and glutamate were measured using a microdialysis analyzer.
Results: Compared with a peak at T4 (after 60 min of rewarming) in the DHCA group, the serum S100 in the SACP group was significantly lower throughout the study. The DHCA group was susceptible to significant increases in the levels of lactate, glycerol, and glutamate and the ratio of lactate/pyruvate as well as decreases in the level of glucose. These microdialysis variables showed only minor changes in the SACP group. There was a positive correlation between cerebral lactate and intracranial pressure during reperfusion in the DHCA group. However, the apoptosis index and C-FOS protein levels were lower in the SACP group.
Conclusion: Metabolic dysfunction is involved in the mechanism of cerebral injury. SACP is a superior neuroprotective strategy for both mild and prolonged DHCA.

Keywords: DHCA, SACP, cerebral injury, neuroprotective strategy, microdialysis, metabolism




Zhixian Tang, Mengya Liang, Guangxian Chen, Jian Rong, Jianping Yao, Zhen Chen, Xiao Yang, Zhongkai Wu. Neuroprotective effect of selective antegrade cerebral perfusion during prolonged deep hypothermic circulatory arrest: Cerebral metabolism evidence in a pig model. Anatol J Cardiol. 2018; 19(1): 2-10

Corresponding Author: Zhongkai Wu, China


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