title: The effectiveness of high-flow regional cerebral perfusion in Norwood stage I palliation.
abstract: OBJECTIVE
  Regional cerebral perfusion (RCP) has been shown to provide cerebral circulatory support during Norwood procedure. In our institution, high-flow RCP (HFRCP) from the right innominate artery has been induced to keep sufficient cerebral and somatic oxygen delivery via collateral vessels. We studied the effectiveness of HFRCP to regional cerebral and somatic tissue oxygenation in Norwood stage I palliation.
  
  
  METHODS
  Seventeen patients, who underwent the Norwood procedure, were separated into two groups: group C (n=6) using low-flow RCP and group H (n=11) using HFRCP (mean flow: 54 vs 92mlkg(-1)min(-1), P<0.0001). The mean duration of RCP was 64±10min (range, 49-86min) under the moderate hypothermia. Chlorpromazine (3.0mgkg(-1)) was given to group H patients before and during RCP to increase RCP flow. The mean radial arterial pressure was kept <50mmHg during RCP. To clarify the effectiveness of HFRCP for cerebral and somatic tissue oxygenation, cerebral regional oxygen saturation (rSO(2)) and systemic venous oxygenation (SvO(2)) during RCP were compared between the two groups. Changes in the lactate level before and after RCP, and changes in the blood urea nitrogen (BUN), creatinine, lactate dehydrogenase (LDH), and creatinine kinase (CK) levels before and after surgery, were also compared between the groups.
  
  
  RESULTS
  Mean rSO(2) was 82.9±9.0% in group H and 65.9±10.7% in group C (P<0.05). Mean SvO(2) during RCP was 98.2±4.3% in group H and 85.4±9.7% in group C (P<0.01). During RCP, lactate concentration significantly increased in group C compared with that in group H (P<0.001). After surgery, the LDH and CK levels significantly increased in group C compared with that in group H (P<0.05).
  
  
  CONCLUSIONS
  Our study revealed that HFRCP preserved sufficient cerebral and somatic tissue oxygenation during the Norwood procedure. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan. kagami111@aol.com
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kohira
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshii
authors.forename: Kei-Ichi
authors.initials: K
authors.lastname: Itatani
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Inoue
mesh_terms: D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood / Q000601:surgery*; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods; D007770:L-Lactate Dehydrogenase / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D016343:Monitoring, Intraoperative / Q000379:methods; D058327:Norwood Procedures / Q000379:methods*; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D003404:Creatinine; D007770:L-Lactate Dehydrogenase