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Selective antegrade cerebral perfusion at two different temperatures compared to hypothermic circulatory arrest – an experimental study in the pig with microdialysis ^,

^a Department of Surgical Sciences, Thoracic Surgery, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
^b Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala University, Uppsala, Sweden

*Corresponding author. Department Thoracic Surgery and Anaesthesia, Uppsala University, SE-751 85 Uppsala, Sweden. Tel.: +46 18 6110000 (operator); fax: +46 18 506143.

E-mail address: ove_jonsson{at}spray.se (O. Jonsson).

Hypothermic arrest and selective antegrade cerebral perfusion (SACP) is widely used during aortic arch surgery. The microdialysis technique monitors biomarkers of cellular metabolism and cellular integrity over time. In this study, the cerebral changes during hypothermic circulatory arrest (HCA) at 20 °C and HCA with SACP at two different temperatures, 20 and 28 °C, were monitored. Twenty-three pigs were divided into three groups. A microdialysis probe was fixated into the forebrain. Circulatory arrest started at a brain and body temperature of 20 °C or 28 °C. Arrest with/without cerebral perfusion (flow 10 ml/kg, max carotid artery pressure 70 mmHg) lasted for 80 min followed by reperfusion and rewarming during 40 min and an observation period of 120 min. The microdialysis markers were registered at six time-points. The lactate/pyruvate ratio (L/P ratio) and the lactate/glucose ratio (L/G ratio) increased significantly (P<0.05), during arrest, in the HCA group. The largest increase of glycerol was found in the group with tepid cerebral perfusion (28 °C) and the HCA group (P<0.05). This study supports the use of SACP over arrest. It also suggests that cerebral metabolism and cellular membrane integrity may be better preserved with SACP at 20 °C compared to 28 °C.

Key Words: Aortic surgery; Hypothermic circulatory arrest; Selective antegrade cerebral perfusion; Cerebral protection; Pig model; Microdialysis

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