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Retrograde brain perfusion beyond the venous values. Hemodynamics and intracellular pH mapping
1Second Department of Surgery, Yamagata University School of Medicine, Japan.
The Journal of Thoracic and Cardiovascular Surgery
|January 1, 1996
Summary
Retrograde brain perfusion protects the brain during hypothermic circulatory arrest. This method, using pressure-regulated cardiopulmonary bypass, maintained higher brain pH compared to circulatory arrest alone.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Physiology
Background:
- Hypothermic circulatory arrest (HCA) is used in complex surgeries but carries risks of brain injury.
- Maintaining adequate cerebral perfusion and pH is critical during HCA.
Purpose of the Study:
- To evaluate the efficacy of retrograde brain perfusion (RBP) in protecting the brain during hypothermia compared to circulatory arrest.
Main Methods:
- Twenty-one dogs underwent RBP via sagittal sinus and superior vena cava at 20°C for 90 minutes.
- Ten dogs underwent 60 minutes of circulatory arrest at 20°C.
- Cerebral blood flow (CBF) and regional intracellular pH were measured using laser flowmetry and neutral red staining.
Main Results:
- RBP maintained CBF at 8.98 ml/100 gm/min with a driving pressure of 29.69 mm Hg.
- RBP maintained brain pH between 6.77–7.14.
- Circulatory arrest resulted in a significant decrease in brain pH (to 5.81–6.43).
Conclusions:
- Retrograde brain perfusion effectively protects the brain during hypothermic conditions.
- A driving pressure above 20 mm Hg is crucial for effective RBP.
- RBP offers a significant neuroprotective advantage over circulatory arrest.