Blood Flow Quantitation by Positron Emission Tomography During Selective Antegrade Cerebral Perfusion

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• 作者：Thomas Tovedal ; PhD^a ; ^{thomas.tovedal@surgsci.uu.se} ; Mark Lubberink ; PhD^b ; Arvid Morell ; PhD^b ; Sergio Estrada ; PhD^c ; Sandeep S.V. Golla ; MS^b ; Gunnar Myrdal ; MD ; PhD^d ; Rickard P.F. Lindblom ; MD ; PhD^d ; Stefan Thelin ; MD ; PhD^d ; Jens Sö ; rensen ; MD ; PhD^b ; Gunnar Antoni ; PhD^c ; Fredrik Lennmyr ; MD ; PhD^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：103
• 期：2
• 页码：610-616
• 全文大小：765 K
• 卷排序：103

文摘

Perfusion strategies during aortic surgery usually comprise hypothermic circulatory arrest (HCA), often combined with selective antegrade cerebral perfusion (SACP) or retrograde cerebral perfusion. Cerebral blood flow (CBF) is a fundamental parameter for which the optimal level has not been clearly defined. We sought to determine the CBF at a pump flow level of 6 mL/kg/min, previously shown likely to provide adequate SACP at 20°C in pigs.MethodsRepeated positron emission tomography (PET) scans were used to quantify the CBF and glucose metabolism throughout HCA and SACP including cooling and rewarming. Eight pigs on cardiopulmonary bypass were assigned to either HCA alone (n = 4) or HCA+SACP (n = 4). The CBF was measured by repeated [15O]water PET scans from baseline to rewarming. The cerebral glucose metabolism was examined by [18F]fluorodeoxyglucose PET scans after rewarming to 37°C.ResultsCooling to 20°C decreased the cortical CBF from 0.31 ± 0.06 at baseline to 0.10 ± 0.02 mL/cm3/min (p = 0.008). The CBF was maintained stable by SACP of 6 mL/kg/min during 45 minutes. After rewarming to 37°C, the mean CBF increased to 0.24 ± 0.07 mL/cm3/min, without significant differences between the groups at any time-point exclusive of the HCA period. The net cortical uptake (Ki) of [18F]fluorodeoxyglucose after rewarming showed no significant difference between the groups.ConclusionsCooling autoregulated the CBF to 0.10 mL/cm3/min, and 45 minutes of SACP at 6 mL/kg/min maintained the CBF in the present model. Cerebral glucose metabolism after rewarming was similar in the study groups.