Partial brachiocephalic perfusion under hypothermic cardiopulmonary bypass. An experimental study

Area of Science:

• Cardiovascular Surgery
• Neurophysiology
• Metabolic Research

Background:

• Hypothermic cardiopulmonary bypass (CPB) is standard for cardiac surgery.
• Maintaining cerebral oxygenation during CPB is critical.
• Partial brachiocephalic perfusion (PBP) is an emerging technique to potentially improve cerebral protection.

Purpose of the Study:

• To evaluate the reliability and safety of partial brachiocephalic perfusion (PBP) under hypothermic cardiopulmonary bypass (CPB).
• To assess electrophysiological, oxygen metabolic, and histological variables during PBP in a canine model.

Main Methods:

• Sixteen mongrel dogs were divided into control (CPB) and PBP groups.
• Both groups underwent 90 minutes of hypothermic CPB (23-25°C).
• Electrophysiological (EEG), cerebral arteriovenous oxygen difference (AVO2), and serum creatine kinase-BB (CK-BB) were monitored.

Main Results:

• Electroencephalogram (EEG) showed progressive slowing and flattening during cooling, with consistent recovery upon rewarming in both groups.
• Cerebral AVO2 difference was significantly lower in the PBP group at 10 minutes compared to controls (P<0.05).
• Serum CK-BB levels increased with CPB duration in both groups, with no significant difference between groups.

Conclusions:

• Partial brachiocephalic perfusion (PBP) under hypothermic cardiopulmonary bypass (CPB) demonstrates reliability and safety in a canine model.
• PBP appears to maintain cerebral oxygen metabolism effectively during hypothermic CPB.
• Further research is warranted to explore PBP's clinical applicability in cardiac surgery.