A Cardiac Surgical Perspective on Hypothermia for Protection of Neural Tissues

Abstract

Background: In clinical and basic science medicine, we often isolate ourselves in silos, unaware of developments in other related disciplines. Our team has had substantial experience, both in the operating room and in the laboratory, with protecting the brain and the spinal cord via hypothermia. Herein, we briefly share this experience with our colleagues in Neurology, eager for comments and advice from the neurologic perspective. Methods: 1) Clinical brain protection via deep hypothermic circulatory arrest (DHCA) for surgery of the aortic arch. For aortic arch replacement (performed for aortic arch aneurysm or aortic dissection), the aortic arch must be opened and native perfusion stopped. We have decades of experience in many hundreds of patients with this technique. This experience is reviewed. 2) Experimental protection of the spinal cord via cooling. We review our laboratory experience with a novel, recirculating cooling catheter for the vulnerable spinal cord. 3) Experimental protection of the brain via an intraventricular cooling catheter. We review our laboratory experience cooling the brain with a balloon-tipped catheter residing the lateral ventricles. Results: 1) Deep hypothermic circulatory arrest for aortic arch surgery provides superb brain protection for periods up to 45 minutes or longer. Clinical neurologic function, and quantitative neurologic tests, show excellent brain preservation. 2) The novel spinal cooling catheter provides excellent cooling of the spinal cord in a large animal model, without apparent injury of any type. 3) The intraventricular brain cooling catheter provides excellent cooling of the brain, documented by both direct temperature probe and high-tech brain imaging. Conclusions: We wish herein (in this article) to share this experience across our disciplines (Cardiac Surgery and Neurology). We welcome advice from the Neurology community on these surgically-directed methods for cooling and protection of neurological tissue in both the brain and the spinal cord.