Low-flow perfusion via the innominate artery during aortic arch operations provides only limited somatic circulatory support

Background: Aortic arch operations in pediatric patients using low-flow perfusion techniques have been standardized to a certain degree, but some of the often-stated beneficial effects have never been proven. Especially, the existence or efficacy of any subdiaphragmal perfusion still remains unclear...

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Published in:European journal of cardio-thoracic surgery 2006-04, Vol.29 (4), p.517-524
Main Authors: Roerick, Olaf, Seitz, Timo, Mauser-Weber, Petra, Palmaers, Thomas, Weyand, Michael, Cesnjevar, Robert
Format: Article
Language:English
Subjects:
Acid-Base Imbalance - etiology
Animals
Animals, Newborn
Aorta, Thoracic - surgery
Aortic arch
Body Temperature
Brachiocephalic Trunk - physiology
Brain Diseases - prevention & control
Cerebrovascular Circulation
Collateral blood flow
Deep hypothermic circulatory arrest
Evoked Potentials, Somatosensory
Heart Arrest, Induced
Hemodynamics
Intraoperative Care - methods
Lactic Acid - blood
Low-flow perfusion
Male
Perfusion
Regional Blood Flow
Swine
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Summary:Background: Aortic arch operations in pediatric patients using low-flow perfusion techniques have been standardized to a certain degree, but some of the often-stated beneficial effects have never been proven. Especially, the existence or efficacy of any subdiaphragmal perfusion still remains unclear. Methods: Twenty-six newborn male piglets (10–15 kg) underwent aortic arch surgery under general anesthesia using either low-flow perfusion via the innominate artery (LF, 30 ml/(kg min), 25 °C, n = 12) or conventional deep hypothermic circulatory arrest (DHCA, 20 °C, n = 14). Cortical somatosensory-evoked potentials (SSEPs), carotid, and subdiaphragmal blood flows were measured. The animals of both groups have been randomized to either pH-stat or alpha-stat management on cardiopulmonary bypass (CPB). Results: During low-flow perfusion via the innominate artery only negligible flows of maximum 1–3 ml/min in the femoral arteries were detected, whereas the right carotid artery flow doubled. During reperfusion, serum-lactate and aspartate amino-transferase (AST) levels were significantly higher compared to the circulatory arrest group, whereas alanine amino-transferase (ALT), gamma-glutamyl transpeptidase (gamma-GT), AP, and creatinine did not show any significant differences. Cortical SSEP returned to preoperative values in all but two low-flow animals. There was no return of SSEP in all piglets operated under deep hypothermic circulatory arrest (p < 0.01). Conclusion: Compared to DHCA, low-flow perfusion via the innominate artery provides superior neuroprotection despite higher tissue temperatures. Although collateral blood flow via the subclavian artery and the circulus arteriosus willisii has often been presumed, only ‘trickle-flow’ with some protective potential was detectable in the femoral arteries during low-flow perfusion. Origin of elevated lactate and AST levels seems to be the lower limbs.
ISSN:1010-7940
1873-734X
DOI:10.1016/j.ejcts.2005.12.048