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Fumikazu Nomura
Joseph M. Forbess
Richard A. Jonas
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Ann Thorac Surg 1996;62:115-122
© 1996 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Influence of Age on Cerebral Recovery After Deep Hypothermic Circulatory Arrest in Piglets

Fumikazu Nomura, MD, Joseph M. Forbess, MD, Richard A. Jonas, MD, Takeshi Hiramatsu, MD, Adre J. du Plessis, MD, Gene Walter, Reegt, Michael E. Stromski, PhD, David H. Holtzman, MD, PhD

Departments of Cardiac Surgery and Neurology, Children's Hospital, and Departments of Surgery and Neurology, Harvard Medical School, Boston, Massachusetts

Accepted for publication February 26, 1996.

Background. In the first weeks of life there are important maturational changes in the central nervous system in many species in energy metabolism, synapse number, and concentration of neuronal excitatory receptors.

Methods. Four groups of 10 piglets (aged 1, 2, 4, and 10 weeks) underwent 1 hour of deep hypothermic circulatory arrest at 15°C, with cooling and rewarming on cardiopulmonary bypass. Cerebral blood flow and metabolic rate measurements and electroencephalographic recordings were obtained from 5 animals per group. The remaining animals underwent cerebral magnetic resonance spectroscopy.

Results. Preoperative cerebral blood flow and glucose consumption were higher at 4 and 10 weeks than at 1 and 2 weeks. Cerebral adenosine triphosphate content decreased more rapidly during deep hypothermic circulatory arrest at 4 and 10 weeks. Phosphocreatine recovery was greater at 30 minutes of reperfusion at 10 weeks compared with 1 week. Recovery of cerebral phosphocreatine/adenosine triphosphate ratio and intracellular pH was remarkably uniform at all ages. Latency to recovery of electroencephalographic activity decreased with increasing age (p = 0.04).

Conclusions. Differences in acute recovery of brain energy metabolism and electroencephalogram after cardiopulmonary bypass and 1 hour of deep hypothermic circulatory arrest in piglets between 1 and 10 weeks of age are small. Further studies are required to correlate these acute findings with subsequent neurologic outcome.




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