Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion

Abstract

Background:Antegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.Methods:To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without (DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.Results:Metabolic profiling of brain was distinctive significantly between the two groups (Q2Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.Conclusions:The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

Elective Aortic Arch Repair: Factors Influencing Neurologic Outcome in 791 Patients

“…Selective antegrade cerebral perfusion, at moderate hypothermia, is currently the most widely used technique for brain protection [8,9]. Like previous studies [10][11][12][13][14], we found ASCP to be a protective factor for PND (OR, 0.37; p < 0.003). As a result, DHCA is no longer used in our center as a surgeon preference but is used only for strict indications (such as hostile reentry).…”

Tissue-specific metabolomic profiling after cardiopulmonary bypass in fetal sheep

“…With the rapid development of omics technology, metabolomics has been used to study CPB-related ischemia-reperfusion injury ( 8 ), acute kidney injury ( 9 ), and cerebral ischemic protection ( 10 ). This study established a fetal sheep model of CPB and used untargeted metabolomics to follow metabolic changes in the fetal heart, liver, brain, kidney, and placenta after bypass.…”