A Comparison of the Perioperative Neurologic Effects of Hypothermic Circulatory Arrest versus Low-Flow Cardiopulmonary Bypass in Infant Heart Surgery

Newburger, Jane W.; Jonas, Richard A.; Wernovsky, Gil; Wypij, David; Hickey, Paul R.; Kuban, Karl; Farrell, David M.; Holmes, Gregory L.; Helmers, Sandra L.; Constantinou, Jules E.C.; Carrazana, Enrique; Barlow, John K.; Walsh, Amy Z.; Lucius, Kristin C.; Share, Jane; Wessel, David; Hanley, Frank L.; Mayer, John E.; Castañeda, Aldo R.; Ware, James H.

doi:10.1056/nejm199310073291501

Cited by 650 publications

(396 citation statements)

References 45 publications

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“…[16][17][18][19][20] Although many improvements have been introduced since the technique was first established, there remain recognized complications secondary to unique physiologic trespasses associated with HCA and CPB. [19][20][21][22] Further refinements of the technique require an appropriate experimental model. In the present study, we developed a HCA model using rats, which was designed to mirror clinical circulatory arrest to the greatest extent possible.…”

Section: Discussionmentioning

confidence: 99%

Un niveau réduit d’hématocrite aggrave les lésions cérébrales après un arrêt circulatoire hypothermique prolongé chez le rat

Wang

Zheng

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: This study tests the hypothesis that low hematocrit (Hct) worsens cerebral injury after prolonged hypothermic circulatory arrest (HCA) in rats, and the mechanism involves variable expression of the genes C-Fos, Bcl-2 and Bax.Methods: A rat HCA model was developed, and 40 animals were randomly assigned to four groups: Sham (sham) group, or Hct groups of Hct 10%, Hct 20% and Hct 30%. After 90 min of HCA at 18°C, physiologic variables were recorded and brain morphological changes were evaluated with light and electron microscopy. Expressions of C-Fos, Bcl-2, Bax in various brain areas were measured by the reverse transcriptase polymerase chain reaction and standard immunohistochemistry techniques. Results:The number of injured neurons in the hippocampus CA1 and parietal cortex in the Hct 10% group (CA1: 11.44 ± 2.52; cortex: 13.65 ± 2.31) exceeded the mean number of injured neurons in the Hct 20% group (CA1: 8.29 ± 1.31; cortex: 10.68 ± 1.24; P < 0.05) and the Hct 30% group. Mean mitochondrial injury scores were greatest at lower Hct levels, while the expression of C-Fos and Bax were highest in the Hct 10% group and lowest in the Hct30% group (P < 0.05). In contrast, the expression of the Bcl-2 mRNA was greatest in the Hct 30% group (P < 0.05). Conclusion:Low Hct worsens cerebral injury after prolonged HCA and CPB in rats, which may relate in part to the variable expression of the genes C-Fos, Bcl-2 and Bax. Hct 10 % (CA1: 11,44 ± 2,52; cortex: 13,65 ± 2,31) que dans le groupe Hct 20 % (CA1 : 8,29 ± 1,31 ; cortex : 10,68 ± 1,24 ; P < 0,05) Méthode : Un modèle d'ACH a été développé chez le rat et on a réparti de façon aléatoire 40 animaux dans quatre groupes : un groupe sans intervention et des groupes Hct de 10 %, 20 % et 30 %. Après un ACH pendant 90 min à 18°C, on a mesuré les variables physiologiques et on a évalué les changements morphologiques dans le cerveau avec la microscopie optique et électronique. On a mesuré l'expression de C-Fos, Bcl-2 et Bax dans différentes régions du cerveau par la réaction en chaîne transcriptase inverse -polymérase et par des techniques habituelles d'immunohistochimie. Résultats : Les neurones CA1 de l'hippocampe et du cortex pariétal ont été atteints en plus grand nombre dans le groupe

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Section: Discussionmentioning

confidence: 99%

Un niveau réduit d’hématocrite aggrave les lésions cérébrales après un arrêt circulatoire hypothermique prolongé chez le rat

Wang

Zheng

et al. 2006

Can J Anesth/J Can Anesth

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“…She also noted a lack of uniformity in type of oxygenator used (bubble vs membrane), presence of arterial line filters, electroencephalographic monitoring and kind and source of postoperative care. More recently, Newburger et al 7 reported seizures occurring in 11% of infants who had undergone a period of total circulatory arrest.…”

Section: Neurological Outcome Of Cardiopulmonary Bypassmentioning

confidence: 99%

Cerebral physiology in paediatric cardiopulmonary bypass

Pua

Bissonnette

1998

Can J Anaesth

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FKCPCPurpose: To analyze studies of neurological injury after open-heart surgery in infants and children and to discuss the effects of cardiopulmonary bypass, hypothermia and deep hypothermic circulatory arrest on cerebral blood flow, cerebral metabolism and brain temperature. Source: Articles were obtained from the databases, Current Science and Medline, from 1966 to present. Search terms include cardiopulmonary bypass(CPB), hypothermia, cerebral blood flow(CBF), cerebral metabolism and brain temperature. Information and abstracts obtained from meetings on the topic of brain and cardiac surgery helped complete the collection of information. Principal findings: In adults the incidence of neurological morbidity is between 7 to 87% with stroke in about 2-5%, whereas the incidence of neurological morbidity increases to 30% in infants and children undergoing cardiopulmonary bypass. Besides the medical condition of the patient, postoperative cerebral dysfunction and neuronal ischaemia associated with cardiac surgery in infants and small children are a combination of intraoperative factors. Deep hypothermic circulatory arrest impairs CBF and cerebral metabolism even after termination of CPB. Inadequate and/or non-homogenous cooling of the brain before circulatory arrest, as well as excessive rewarming of the brain during reperfusion are also major contributory factors. Conclusion: Newer strategies, including the use of low-flow CPB, pulsatile CPB, pH-stat acid-base management and a cold reperfusion, are being explored to ensure better cerebral protection, Advances in monitoring technology and better understanding of the relationship of cerebral blood flow and metabolism during the different modalities of cardiopulmonary bypass management will help in the medical and anaesthetic development of strategies to improve neurological and developmental outcomes.Objectif: Examiner les Etudes portant sur les atteintes neurologiques survenues apr& une chirurgie b. coeur ouvert chez les bEbEs et les enfants et discuter des effets de la circulation extracorporelle, de l'hypothermie et de l'arr~t circulatoire sous hypothermie profonde sur le debit sanguin c&~bral, sur le m&abolisme c&Ebral et sur la temperature du cerveau. Sources documentaires : Des articles ont &E choisis ~ partir de bases de donnEes, Current Science et Medline, de 1966 ~ aujourd'hui. Les mots-cl& utilis& Etaient : circulation extracorporelle (CEC), hypothermie, debit sanguin cErEbral (DSC), mEtabolisme cErEbral et temperature du cerveau. Les informations et les rEsumEs obtenus & la suite de sEminaires sur le cerveau et la chirurgie cardiaque ont permis de completer la cueillette de donn&s. I)onn&s principales : Chez les adultes, l'incidence de morbiditE neurologique avec accident vasculaire est de 7 87 % clans 2 ~. S % des cas tandis que l'incidence de morbiditE neurologique augmente & 30 % chez les bEb~s et les enfants subissant une circulation extracorporelle. La condition mEdicale du patient raise & part, le d&~glement cErEbral postop&atoire et l'ischEmie neu...

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“…The prevailing view is that chronic cyanosis and multiple cardiopulmonary bypass surgeries early in life lead to cognitive, motor, and behavioral deficits later in life (6,16). However, recent studies have implicated additional factors in the relationship between CNS abnormalities identified in neonates after birth but before surgery (17,18).…”

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confidence: 99%

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

et al. 2013

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Background: Hypoplastic left heart syndrome (HLHS) is associated with significant mortality and morbidity. Fetal head growth abnormalities have been identified in a subset of HLHS fetuses, but it is unclear whether specific patterns of maladaptive growth affect clinical outcomes. We hypothesized that poor fetal head growth is associated with an increased frequency of adverse clinical outcomes. Methods: We retrospectively examined a cohort of HLHS patients from midgestation to 1 y of age. Fetal and birth anthropometric measurements were analyzed using the Olsen standard, and clinical outcomes were obtained. results: A total of 104 HLHS patients were identified over a 12-y period; fetal data were available in 38 cases. HLHS neonates demonstrated a high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%). Allcause mortality was 31% at 30 d and 43% at 1 y. Neurologic outcomes were observed in 12% of patients and were significantly increased with microcephaly (43 vs. 4%; P = 0.02). The average length of hospital stay following stage I palliation was 33.4 ± 33 d, correcting for early death. conclusion: In term nonsyndromic HLHS, fetal and neonatal microcephaly are associated with early adverse neurologic outcomes but not mortality.

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A Comparison of the Perioperative Neurologic Effects of Hypothermic Circulatory Arrest versus Low-Flow Cardiopulmonary Bypass in Infant Heart Surgery

Cited by 650 publications

References 45 publications

Un niveau réduit d’hématocrite aggrave les lésions cérébrales après un arrêt circulatoire hypothermique prolongé chez le rat

Un niveau réduit d’hématocrite aggrave les lésions cérébrales après un arrêt circulatoire hypothermique prolongé chez le rat

Cerebral physiology in paediatric cardiopulmonary bypass

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

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