AI Article Synopsis
- Cerebral protection during aortic arch repair can be achieved through regional cerebral perfusion (RCP) via the innominate artery, and this study focuses on blood flow in both brain hemispheres during this process.
- Fourteen infants undergoing RCP had their cerebral blood flow assessed using advanced imaging techniques, with measurements taken during both full-flow total body perfusion (TBP) and RCP at a target temperature of 28°C.
- Results indicated that while RCP provided near-symmetric blood flow intensity and comparable cerebral metrics between hemispheres, there was a significant decrease in regional cerebral oximetry in the right hemisphere during RCP compared to TBP, suggesting further studies are needed to evaluate the neurodevelopmental outcomes of RCP.
Article Abstract
Background: 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.
Methods: Fourteen 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 · min) 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 (rSO) was assessed. Comparing both hemispheres, measurements were performed at target temperature (28°C) during full-flow total body perfusion (TBP) and RCP.
Results: A 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 rSO, 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 rSO in the right hemisphere during TBP (82% ± 9%) compared with RCP (74% ± 11%, p = 0.036).
Conclusions: Bilateral assessment of cerebral rSO 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.
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| http://dx.doi.org/10.1016/j.athoracsur.2016.05.088 | DOI Listing |
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