Document Detail


Regional high-flow cerebral perfusion improves both cerebral and somatic tissue oxygenation in aortic arch repair.
MedLine Citation:
PMID:  20667356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Regional cerebral perfusion provides cerebral circulatory support during aortic arch reconstruction. We report the effectiveness of high-flow regional cerebral perfusion (HFRCP) from the right innominate artery to maintain sufficient cerebral and somatic oxygen delivery through collateral vessels.
METHODS: Frontal cerebral and thoracolumbar probes to measure somatic regional oxygen saturation (rSo(2)) were used to continuously measure oxygenation during cardiopulmonary bypass in 18 patients (weight, 2.1 to 4.3 kg) who underwent arch reconstruction using HFRCP (mean flow, 82; range, 43 to 108 ml/kg/min). Procedures included 9 Norwood procedures, 5 coarctation of aorta/interruption of aorta complex repairs, and 4 aortic arch repairs for a single ventricle. Mean HFRCP duration was 51 + or - 17 minutes under moderate hypothermia. Mean radial arterial pressure was kept at less than 50 mm Hg during HFRCP, and chlorpromazine (mean dose, 2.8 mg/kg) was given to all patients before and during HFRCP to increase regional cerebral perfusion flow. Plasma lactate concentration was measured before and after HFRCP.
RESULTS: During HFRCP, mean cerebral rSo(2) was 78.8% + or - 9.5%, somatic rSo(2) was 65.4% + or - 12.1%, and lactate concentration increased from 3.8 + or - 2.2 to 5.5 + or - 2.1 mmol/L. There was significant correlation between regional cerebral perfusion flow and somatic rSo(2). Significant inverse correlations were noted between regional cerebral perfusion flow and the increase of lactate concentration and between somatic rSo(2) and the increase of lactate concentration.
CONCLUSIONS: High-flow regional cerebral perfusion preserved sufficient cerebral and somatic tissue oxygenation during aortic arch repair. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
Authors:
Kagami Miyaji; Takashi Miyamoto; Satoshi Kohira; Kei-Ichi Itatani; Takahiro Tomoyasu; Nobuyuki Inoue; Kuniyoshi Ohara
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-29     Completed Date:  2010-08-24     Revised Date:  2011-06-14    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  593-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Surgery, Kitasato University, School of Medicine, Kitasato 1-15-1, Sagamihara 228-8555, Japan. kagami111@aol.com
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MeSH Terms
Descriptor/Qualifier:
Aorta, Thoracic / surgery*
Brain / metabolism*
Cardiopulmonary Bypass*
Cerebrovascular Circulation*
Humans
Infant
Infant, Newborn
Intraoperative Care / methods*
Oxygen / metabolism*
Perfusion / methods
Prospective Studies
Regional Blood Flow
Chemical
Reg. No./Substance:
7782-44-7/Oxygen
Comments/Corrections
Comment In:
Ann Thorac Surg. 2011 May;91(5):1650-1   [PMID:  21524492 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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