Comparable Cerebral Blood Flow in Both Hemispheres During Regional Cerebral Perfusion in Infant Aortic Arch Surgery

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• 作者：André ; Rü ; ffer ; MD^a ; ^{andre.rueffer@uk-erlangen.de} ; Philip Tischer ; MD^a ; Frank Mü ; nch ; MCT^a ; Ariawan Purbojo ; MD^a ; Okan Toka ; MD^b ; Wolfgang Rascher ; MD^c ; Robert Anton Cesnjevar ; MD^a ; Jö ; rg Jü ; ngert ; MD^c
• 关键词：CPB ; cardiopulmonary bypass ; ICA ; internal carotid artery ; MCA ; medial cerebral artery ; RCP ; regional cerebral perfusion ; rSO2 ; regional cerebral oxygen saturation ; TAV ; time average velocity ; TBP ; total body perfusion ; 3D ; three-dimensional ; 2D ; two-dimensional
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：103
• 期：1
• 页码：178-185
• 全文大小：1298 K
• 卷排序：103

文摘

Cerebral protection during aortic arch repair can be provided by regional cerebral perfusion (RCP) through the innominate artery. This study addresses the question of an adequate bilateral blood flow in both hemispheres during RCP.MethodsFourteen infants (median age 11 days [range, 3 to 108]; median weight, 3.6 kg [range, 2.8 to 6.0 kg]) undergoing RCP (flow rate 54 to 60 mL · kg−1 · min−1) were prospectively included. Using combined transfontanellar/transtemporal two- and three-dimensional power/color Doppler sonography, cerebral blood flow intensity in the main cerebral vessels was displayed. Mean time average velocities were measured with combined pulse-wave Doppler in the basilar artery, and both sides of the internal carotid, anterior, and medial cerebral arteries. In addition, bifrontal regional cerebral oximetry (rSO2) was assessed. Comparing both hemispheres, measurements were performed at target temperature (28°C) during full-flow total body perfusion (TBP) and RCP.ResultsA regular circle of Willis with near-symmetric blood flow intensity to both hemispheres was visualized in all infants during both RCP and TBP. In the left internal carotid artery, blood flow direction was mixed (retrograde, n = 5; antegrade, n = 8) during TBP and retrograde during RCP. Comparison between sides showed comparable cerebral time average velocities and rSO2, except for higher time average velocities in the right internal carotid artery (TBP p = 0.019, RCP p = 0.09). Unilateral comparison between perfusion methods revealed significantly higher rSO2 in the right hemisphere during TBP (82% ± 9%) compared with RCP (74% ± 11%, p = 0.036).ConclusionsBilateral assessment of cerebral rSO2 and time average velocity in the main great cerebral vessels suggests that RCP is associated with near-symmetric blood flow intensity to both hemispheres. Further neurodevelopmental studies are necessary to verify RCP for neuroprotection during aortic arch repair.