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eComment: Selective antegrade cerebral perfusion and metabolicsuppression

Hannover Medical School, Cardiac, Thoracic,Transplantation and Vascular Surgery, Hannover, Germany

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

We read with great interest the article by Jonsson and co-workers dealing with the topic of hypothermic circulatory arrest (HCA) and different temperatures for selective antegrade cerebral perfusion (SACP) [1]. In their study, they were able to show an advantage of SACP at 20 °C compared to HCA alone or SACP at 28 °C by using microdialysis. Interestingly, their findings were not consistent in the study groups. From these data they speculated that 28 °C does not provide sufficient brain protection in their setup. These findings basically confirm the results from two studies from our group [2, 3]. In the first study we were able to demonstrate the advantages of additional SACP compared to HCA alone [2]. Despite an improved neurophysiological recovery and lower intracranial pressures (ICP), SACP significantly reduced tissue acidosis in the brain. In another study, the impact of different temperatures for SACP was elucidated [3]. SACP at 20 °C provided adequate brain protection in comparison to the potential detrimental effects of moderate (30 °C) or profound (10 °C) temperatures. This was proven by histopathology, sagittal sinus saturation as well as molecular genetics. Again, in both studies as well as previous ones, the ICP was a reliable indicator for neurological injury [4]. In this context we are still not able to answer the questions whether the raise in ICP is a reflection of cerebral injury or just causes aggravation. As the authors mentioned in their limitations, no serum values of the different microdialysis parameters were analyzed. Therefore, it is not possible to distinguish the source of metabolites. In this context, the integrity of the blood brain barrier is not well known. This could be of utmost importance for further clinical investigations for non- or less-invasive detection of cerebral injury [5].

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1. Jonsson O, Myrdal G, Zemgulis V, Valtysson J, Hillered L, Thelin S. Selective antegrade cerebral perfusion at two different temperatures compared to hypothermic circulatory arrest – an experimental study in the pig with microdialysis. Interact CardioVasc Thorac Surg 2009;8:647–653.[Abstract/Free Full Text]
2. Hagl C, Khaladj N, Peterss S, Hoeffler K, Winterhalter M, Karck M, Haverich A. Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model. Eur J Cardiothorac Surg 2004;26:73–80.[Abstract/Free Full Text]
3. Khaladj N, Peterss S, Oetjen P, von Wasielewski R, Hauschild G, Karck M, Haverich A, Hagl C. Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection? Eur J Cardiothorac Surg 2006;30:492–498.[Abstract/Free Full Text]
4. Hagl C, Khaladj N, Weisz DJ, Zhang N, Guo LJ, Bodian CA, Spielvogel D, Griepp RB. Impact of high intracranial pressure on neurophysiological recovery and behavior in a chronic porcine model of hypothermic circulatory arrest. Eur J Cardiothorac Surg 2002;22:510–516.[Abstract/Free Full Text]
5. Khaladj N, Teebken OE, Hagl C, Wilhelmi MH, Tschan C, Weissenborn K, Lichtinghagen R, Hoy L, Haverich A, Pichlmaier M. The role of cerebrospinal fluid S100 and lactate to predict clinically evident spinalcord ischaemia in thoraco-abdominal aortic surgery. Eur J Vasc Endovasc Surg 2008;36:11–19.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nawid Khaladj Axel Haverich Christian Hagl Permission Requests Google Scholar Articles by Khaladj, N. Articles by Hagl, C. PubMed PubMed Citation Articles by Khaladj, N. Articles by Hagl, C. Related Collections Related Article