Regional low-flow perfusion improves neurologic outcome compared with deep hypothermic circulatory arrest in neonatal piglets

被引:50
作者
Myung, RJ
Petko, M
Judkins, AR
Schears, G
Ittenbach, RF
Wabiel, RJ
DeCampli, WM
机构
[1] Childrens Hosp Philadelphia, Div Cardiothorac Surg, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Dept Pathol & Lab Med, Philadelphia, PA 19104 USA
[3] Childrens Hosp Philadelphia, Dept Anesthesia & Crit Care, Philadelphia, PA 19104 USA
[4] Childrens Hosp Philadelphia, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
关键词
D O I
10.1016/j.jtcvs.2003.11.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Regional low-flow perfusion is an alternative to deep hypothermic circulatory arrest, but whether regional low-flow perfusion improves neurologic outcome after deep hypothermic circulatory arrest in neonates remains unknown. We tested neurologic recovery after regional low-flow perfusion compared with deep hypothermic circulatory arrest in a neonatal piglet model. Methods: Sixteen neonatal piglets underwent cardiopulmonary bypass, were randomized to 90 minutes of deep hypothermic circulatory arrest or regional low-flow perfusion (10 mL (.) kg(-1) (.) min(-1)) at 18degreesC, and survived for 1 week. Standardized neurobehavioral scores were obtained on postoperative days 1, 3, and 7 (0 = no deficit to 90 = brain death). Histopathologic scores were determined on the basis of the percentage of injured and apoptotic neurons in the neocortex and hippocampus by hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling (0 = no injury to 4 = diffuse injury). Differences between groups were tested by using the Wilcoxon rank sum test, and results are listed as medians within a range. Results: There were no significant differences between groups during cardiopulmonary bypass. Postoperative neurobehavioral scores were abnormal in 25% (2/8) of the regional low-flow perfusion animals versus 88% (7/8) of controls. Regional low-flow perfusion animals had significantly less neurologic injury compared with controls on postoperative day 1 (0.00 [range, 0-5] vs 12.5 [range, 0-52]; P < .008). There was a trend for less severe injury in the regional low-flow perfusion group (2.0 [range, 1-4] vs 0.0 [range, 0-50]; P = .08) on hematoxylin and eosin. The degree of apoptosis was significantly less in the regional low-flow perfusion group (0.0 [range, 0-1] vs 2.5 [range, 0-4]; P = .03). Conclusions: Regional low-flow perfusion decreases neuronal injury and improves early postoperative neurologic function after deep hypothermic circulatory arrest in neonatal piglets.
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页码:1051 / 1057
页数:7
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