Optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20° C

Miyamoto, Kensaku; Kawashima, Yasunaru; Matsuda, Hikaru; Okuda, A; Maeda, Shoji; Hirose, Hajime

doi:10.1016/s0022-5223(19)35822-2

Cited by 62 publications

(15 citation statements)

References 11 publications

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“…In a similar model, flow rates of 20 ml«kg" 1# min~1 also resulted in inadequate cerebral metabolism. 86 We found that flows of 5-10 ml/kg/min were sufficient to preserve patterns of normal cerebral metabolic recovery in neonatal piglets following a period of deep hypothermic arrest of one hour at 18 °C (Figure 2). 20 These data are consistent with predicted safe flows at this temperature.…”

Section: The Phase Of Surgical Intervention Bypass Using Low Flowmentioning

confidence: 84%

“…Most importantly, they demonstrated the association of these findings with poor neurologic outcome. Other experimental investigations using CK-BB, 1314 cerebral blood flow, 15 cerebral metabolic rate for oxygen, 11>16 electroencephalography 17 and brain histology 1819 have provided further collateral evidence of cerebral dysfunction associated with deep hypothermic arrest, linking altered metabolism with a poorer outcome. In addition, an association between increasing duration of the ischemic period and worsening histopathologic changes suggestive of irreversible injury have been observed by some.…”

Section: Effect On the Brain Of Heart Surgery In The Youngmentioning

confidence: 99%

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Mechanisms of injury and methods of protection of the brain during cardiac surgery in neonates and infants

et al. 1993

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With substantial effort and research devoted to improving surgical techniques and myocardial protection, superb results have been achieved for repair of complex congenital heart defects in children. As a result, investigative efforts now have begun to examine the quality of life for patients surviving these operations. Because these neonates and infants are exposed to severe physiologic extremes of temperature (15–18 °C) and severe alterations from normal perfusion (total circulatory arrest), the nature of long-term neuropsychological outcome has been a prominent concern. Recent preliminary reports suggest that transient and permanent neuropsychologic injury occur in as many as 25% of all infants undergoing hypothermic cardiopulmonary bypass with circulatory arrest.'Since improved surgical techniques have significantly reduced rates of operative mortality and cardiac morbidity, one of the greatest risks remaining for the patient with congenital heart disease may be long term neuropsychologic and developmental abnormalities.

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Section: The Phase Of Surgical Intervention Bypass Using Low Flowmentioning

confidence: 84%

Section: Effect On the Brain Of Heart Surgery In The Youngmentioning

confidence: 99%

Mechanisms of injury and methods of protection of the brain during cardiac surgery in neonates and infants

et al. 1993

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“…In surface‐cooled dogs, normothermic O 2 consumption is reduced by 50% at a rectal temperature of 30°C and to 20% at 20°C 18 . In dogs, reported pump flows for normothermia are 100–150 mL/kg/min 19 and 80 mL/kg/min 20 and optimal brain perfusion during deep hypothermic CPB (20°C) is 30 mL/kg/min 21 . Lew et al 11 reported profound HT (15–18°C) using blood‐cooling with a heat‐exchanger for 45 minutes with low perfusion flow (20 mL/kg/min) for 1 hour ACC in dogs weighing 7–8 kg, and mentioned that increased sensitivity to adverse sequelae of CPB may be associated with the small patient size.…”

Section: Discussionmentioning

confidence: 99%

Open Heart Surgery with Deep Hypothermia and Cardiopulmonary Bypass in Small and Toy Dogs

Kanemoto¹,

Taguchi²,

Yokoyama³

et al. 2010

Veterinary Surgery

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Objective:To evaluate open heart surgery with deep surface-induced hypothermia (sHT) and low-flow cardiopulmonary bypass (CPB) in small and toybreed dogs. Study Design: Case series. Animals: Small breed dogs (n = 8) weighing o 5.5 kg with naturally occurring cardiac disease. Methods: Deep sHT under isoflurane anesthesia and low-flow rate CPB with a small-volume prime circuit were used. Ventricular septal defect was closed directly in 2 dogs and severe mitral regurgitation was corrected with mitral valvuloplasty (MVP) in 5 dogs and mitral valve replacement in 1 dog. Results: All dogs survived surgery; 1 dog died 6 days and 1 died 2 months after MVP. The other 6 dogs lived (mean follow-up, 32.8 months; range, 12-65 months). Mean body weight at surgery was 3.6 kg (range, 2-5.3 kg). Mean lowest esophageal temperature was 21.41C (range, 19.8-23.81C). Mean lowest pump flow volume was 29.2 mL/kg/min (range, 9.4-57.7 mL/kg/min) during aortic crossclamping (mean, 53.5 minutes; range, 25-79 minutes). Mean hematocrit before CPB was 38.6% (range, 33-47%) and 20.3% (range, 13-24%) during CPB with a small circuit priming volume of 225-260 mL. Conclusion: Deep sHT with low-flow rate CPB may be used for open heart surgery in small dogs weighing o 5.5 kg. Clinical Relevance: Open heart surgery for selected congenital defects and acquired defects in small and toy-breed dogs may be successfully performed using deep sHT and CPB.Surgical correction of acquired and congenital heart diseases is not commonly performed in small dogs (body weight o 5.5 kg) because cardiopulmonary bypass (CPB) is more difficult.

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“…Our cerebral perfusion rates via innominate artery are higher than those of Zilstra [44] in normal adult cerebral blood flow, however. Miyamoto et al [45] also published experimental data stating that an optimum perfusion flow rate of the brain during deep hypothermic cardio~ pulmonary bypass is 30 ml/kg/minute without occurrence of cerebral oxygen debt in the brain with resulting anaerobic metabolism…”

Section: Discussionmentioning

confidence: 99%

Selective cerebral perfusion via innominate artery in aortic arch replacement without deep hypothermic circulatory arrest

Wozniak¹,

Dapper²,

Zickmann³

et al. 1999

Int J Angiol

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Optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20° C

Cited by 62 publications

References 11 publications

Mechanisms of injury and methods of protection of the brain during cardiac surgery in neonates and infants

Mechanisms of injury and methods of protection of the brain during cardiac surgery in neonates and infants

Open Heart Surgery with Deep Hypothermia and Cardiopulmonary Bypass in Small and Toy Dogs

Selective cerebral perfusion via innominate artery in aortic arch replacement without deep hypothermic circulatory arrest

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