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No flow or low flow? A study of the ischemic marker creatine kinase BB after deep hypothermic procedures
R Rossi1, J van der Linden, R Ekroth
1Brompton Hospital, London, England.
Insights
Deep hypothermic procedures for complex congenital heart malformations showed similar increases in cerebral injury markers, creatine kinase isoenzyme BB, regardless of circulatory arrest or low-flow strategies. Preoperative hemoglobin and blood glucose influenced these levels.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Neuroprotection
Background:
- Complex congenital heart malformations often require surgical intervention with deep hypothermic cardiopulmonary bypass.
- Assessing cerebral injury during these procedures is critical for patient outcomes.
- Understanding the impact of different cooling strategies on neurological markers is essential.
Purpose of the Study:
- To compare cerebral injury markers between total circulatory arrest and reduced-flow techniques during deep hypothermia in pediatric cardiac surgery.
- To investigate the relationship between preoperative factors and cerebral injury markers.
Main Methods:
- Serial measurements of creatine kinase isoenzyme BB (CK-BB) in 27 children undergoing deep hypothermic procedures (15°C).
- Comparison between a total circulatory arrest group and a low-flow (25% of normal) group.
- Analysis of CK-BB levels in relation to age, size, hemoglobin, blood glucose, and blood gases.
Main Results:
- Both total circulatory arrest and low-flow groups exhibited significant increases in CK-BB post-procedure.
- No statistically significant difference in CK-BB levels was observed between the two groups.
- CK-BB levels were positively correlated with preoperative hemoglobin and blood glucose.
Conclusions:
- Both circulatory arrest and low-flow strategies during deep hypothermia result in comparable elevations of cerebral injury markers in pediatric cardiac surgery.
- Preoperative hemoglobin and blood glucose levels may be predictive factors for cerebral injury during these procedures.
Abstract:
Twenty-seven children with complex congenital heart malformations necessitating early repair were studied before and after deep hypothermic procedures. The children were allocated into two groups. One group underwent total circulatory arrest (40 +/- 6 minutes). In the other group perfusion was maintained during deep hypothermia but reduced a 25% of normal at normothermia. The temperature was reduced to 15 degrees C (nasopharynx) in both groups with a combination of topical and core cooling. To study cerebral injury, were made serial measurements of creatine kinase isoenzyme BB from arterial samples before and for 8 hours after the deep hypothermic procedure. Creatine kinase isoenzyme BB increased after both procedures from 4.3 +/- 0.9 ng/ml to 10.4 +/- 1.8 ng/ml in the circulatory arrest group and from 2.8 +/- 0.7 ng/ml to 9.9 +/- 1.9 ng/ml in the low-flow group (no significant difference). The results were analyzed in relation to age, size, study group, hemoglobin, blood glucose, and blood gases. The creatine kinase BB levels were positively related to preoperative hemoglobin and blood glucose values before the hypothermic procedures.