Comparison of metabolic responses to deep hypothermic total circulatory arrest and retrograde cerebral perfusion in an experimental model

Abstract

An experimental study was designed to search the effectiveness of retrograde cerebral perfusion which is presently used as cerebral protection method for the surgery of arcus aorta. Twelve dogs were subjected to the study. Six of them were remained in total circulatory arrest at 20 °C for 60 min. Retrograde cerebral perfusion was done again at 20 °C for 1 h for the other six dogs. Tumor necrosis factor (TNF), P-selectin, Intracelluler Adhesion Molecule (ICAM), Creatine Phosphokinase (CPK-BB) and tissue Adenosine triphosphate (ATP) levels were measured, before the cardiopulmonary bypass at 37 °C and during perfusion period at 5, 60 min and 4 h. Tissue ATP level for retrograde cerebral perfusion group was 3.99±0.7 mcmol/g tissue and 2.86±0.1 mcmol/g tissue for total circulatory arrest group at fourth hour ( p<0.05). TNF level was significantly higher in total circulatory arrest group than retrograde cerebral perfusion group ( p<0.05). The samples taken at fourth hour of reperfusion showed the TNF level was, 162.55±13.1 pcg/ml for total circulatory arrest group and this value was 12.5±3.4 pcg/ml for retrograde cerebral perfusion group. ICAM (Intracelluler Adhesion Molecule) level was higher in total circulatory arrest group (18.75±3.6 ng/ml) when compared to retrograde cerebral perfusion group (8.75±1.8 ng/ml) ( p<0.05). All parameters showed that retrograde cerebral perfusion preserved the brain functions better comparing with total circulatory arrest. The time necessary for aortic surgery may be provided by the retrograde cerebral perfusion technique.