The Changes of Cerebral Metabolic and Hemodynamic Parameters , Brain Histology , and Serum Levels of Neuron-Specific Enolase During Retrograde Cerebral Perfusion Under Pofound Hypothermic total Circulatory Arrest in Pigs

Kim, Gyung Hwan; An, Hyuk

Abstract

BACKGROUND: Retrograde cerebral perfusion(RCP) is currently used for brain protection during aorta surgery, however, for the safety of it, various data published so far are insufficient. We performed RCP using pig and investiaged various parameters of cerebral metabolism and brain injury after RCP under deep hypothermia. MATERIAL AND METHOD: We used two experimental groups: in group I(7 pigs, 20 kg), we performed RCP for 120 minutes and in group II (5 pigs, 20 kg), we did it for 90 minutes. Nasopharyngeal temperature, jugular venous oxygen saturation, electroencephalogram were continuously monitored, and we checked the parameters of cerebral metabolism, histological changes and serum levels of neuron-specific enolose(NSE) and l actic dehydrogenase(LDH). Central venous pressure during RCP was mainained in the range of 25 to 30 mmHg. RESULT: Perfusion flow rates(ml/min) during RCP were 130+/-57.7(30 minutes), 108.6+/-55.2(60 minutes), 107.1+/-58.8(90 minutes), 98.6+/-58.7(120 minutes) in group I and 72+/-11.0(30 minutes), 72+/-11.0(60 minutes), 74+/-11.4(90 minutes) in group II. The ratios of drain flow to perfusion flow were 0.18(30 minutes), 0.19(60 minutes), 0.17(90 minutes), 0.16(120 minutes) in group I and 0.21, 0.20, 0.17 in group II. Oxygen consumptions(ml/min) during RCP were 1.80+/-1.37(30 minutes), 1.72+/-1.23(60 minutes), 1.38+/-0.82(90 minutes), 1.18+/-0.67(120 minutes) in group I and 1.56+/-0.28(30 minutes), 1.25+/-0.28(60 minutes), 1.13+/-0.26(90 minutes). We could observe an decreasing tendency of oxygen consumption after 90 minutes of RCP in group I. Cerebrovascular resistance(dynes sec cm-5) during RCP in group I incrased from 71370.9+/-369145.5 to 83920.9+/-49949.0 after the time frame of 90 minutes(p<0.05). Lactate(mg/min) appeared after 30 minutes of RCP and the levels were 0.15+/-0.07(30 minutes), 0.18+/-0.10(60 minutes), 0.19+/-0.19(90 minutes), 0.18+/-0.10(120 minutes) in group I and 0.13+/-0.09(30 minutes), 0.19+/-0.03(60 minutes), 0.29+/-0.11(90 minutes) in group II. Glucose utilization, exudation of carbon dioxide, differences of cerebral tissue acidosis between perfusion blood and drain blood were maintained constantly during RCP. Oxygen saturation levels(%) in drain blood during RCP were 22.9+/-4.4(30 minutes), 19.2+/-4.5(60 minutes), 17.7+/-2.8(90 minutes), 14.9+/-2.8(120 minutes) in group I and 21.3+/-8.6(30 minutes), 20.8+/-17.6(60 minutes), 21.1+/-12.1(90 minutes) in group II. There were no significant changes in cerebral metabolic parameters between two groups. Differences in serum levels of NSE and LDH between perfusion blood and drain blood during RCP showed no statistical significance. Serum levels of NSE and LDH after resuming of cardipulmonary bypass decreased to the level before RCP. Brain water contents were 0.73+/-0.03 in group I and 0.69+/-0.06 in group II and were higher than those of the controls(p<0.05). The light microscopic findings of cerebral neocortex, basal ganglia, hippocampus(CA1 region) and cerebellum showed no evidence of cerebral injury in two groups and there were no different electron microscopy in both groups(neocortex, basal ganglia and hippocampus), but they were thought to be reversible findings.
CONCLUSIONS
Although we did not proceed this study after survival of pigs, we could perform the RCP successfully for 120 minutes with minimal cerebral metabolism and no evidence of irreversible brain damage. The results of NSE and LDH during and after RCP should be reevaluated with survival data.