Abstract 16518: Does Retrograde Perfusion via the Superior Vena Cava During Deep Hypothermic Circulatory Arrest Reach the Brain? An In-Vivo Study Using S-100β in Humans
Introduction: The optimal technique of brain perfusion during circulatory arrest remains controversial. Retrograde perfusion (RCP) via the superior vena cava (SVC) has produced good clinical results. However, animal studies suggest that RCP is unable to perfuse the brain and that RCP blood reaches the arterial system via arterio-venous shunts, without passing through the cerebral parenchyma.
Hypothesis: We sought to evaluate whether RCP circulates through the brain parenchyma in humans during deep hypothermic circulatory arrest (DHCA). We used S-100β, a protein with very high neuro-sensitivity, as a marker of circulation in the cerebral parenchyma. We hypothesized that a significant difference in S-100β levels between the blood infused in the SVC and the effluent blood returning in the carotid artery (CA) during RCP, should be regarded as a sign of the circulation of RCP blood through the brain parenchyma.
Methods: We enrolled 10 nonconsecutive patients undergoing elective arch surgery using DHCA and RCP. Circulating S-100β levels were measured at baseline. During DHCA and RCP the difference in S-100β between the SVC and the CA was evaluated after 10 minutes of arrest and immediately before resumption of the circulation. All S-100β levels were evaluated using ELISA.
Results: Mean DHCA duration was 22.4±7.9 minutes. Mean S-100β level at baseline was 92.5±54.9 μg/L. After 10 minutes of DHCA the level of S-100β in the CA was significantly higher than in the SVC (936.9±326.3 vs. 810.9±307.4 μg/L, p=0.0021). This difference was enhanced at the second DHCA sample (1113.8±334.2 vs. 920.5±340.0 μg/L, p=0.0002). There was a statistically significant correlation between the duration of DHCA and the percent difference in S-100β level between the SVC and the CA (Spearman correlation coefficient=0.902).
Conclusion: RCP is able to perfuse the brain parenchyma in humans during DHCA.
Author Disclosures: M. Gaudino: None. N. Ivascu: None. M. Cushing: None. C. Lau: None. I. Gambardella: None. L.N. Girardi: None.
- © 2016 by American Heart Association, Inc.