Regional low-flow perfusion improves neurologic outcome compared with deep hypothermic circulatory arrest in neonatal piglets.
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 18 degrees C, 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.
Myung
Richard J
RJ
Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, PA 19104, USA.
Petko
Matus
M
Judkins
Alexander R
AR
Schears
Gregory
G
Ittenbach
Richard F
RF
Waibel
Robert J
RJ
DeCampli
William M
WM
D000818:Animals; D000831:Animals, Newborn; D017209:Apoptosis / Q000502:physiology; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology*; D010478:Chemotherapy, Cancer, Regional Perfusion; D004195:Disease Models, Animal; D006324:Heart Arrest, Induced; D006624:Hippocampus / Q000293:injuries / Q000503:physiopathology; D007036:Hypothermia, Induced; D020287:In Situ Nick-End Labeling; D008955:Models, Cardiovascular; D009336:Necrosis; D009460:Neurologic Examination; D009474:Neurons / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D013552:Swine