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Deep hypothermic circulatory arrest in cyanotic piglets is associated with increased neuronal necrosis

Published online by Cambridge University Press:  23 December 2020

Matus Petko ,
Richard J. Myung ,
Lindsay E. Volk Open the ORCID record for Lindsay E. Volk [Opens in a new window] ,
Alexander R. Judkins ,
Richard F. Ittenbach  and
J. William Gaynor
Matus Petko
Affiliation:
The Heart Hospital, University College London, London, UK
Richard J. Myung
Affiliation:
Wellstar Cardiovascular Surgery, Atlanta, GA, USA
Lindsay E. Volk*
Affiliation:
Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Alexander R. Judkins
Affiliation:
Department of Pathology & Laboratory Medicine, Children’s Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, USA
Richard F. Ittenbach
Affiliation:
Dvision of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
J. William Gaynor
Affiliation:
Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: Dr L. E. Volk, MD, MPH, Rutgers Robert Wood Johnson Medical School, Department of General Surgery, 125 Patterson Street, Clinical Academic Building 7300, New Brunswick, NJ08901, USA. Tel: 732-235-6096; Fax: 732-235-6003. E-mail: volkli@rwjms.rutgers.edu
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Abstract

Background:

The contribution of neonatal cyanosis, inherent to cyanotic congenital heart disease, to the magnitude of neurologic injury during deep hypothermic circulatory arrest has not been fully delineated. This study investigates the impact of cyanosis and deep hypothermic circulatory arrest on brain injury.

Methods:

Neonatal piglets were randomised to placement of a pulmonary artery to left atrium shunt to create cyanosis or sham thoracotomy. At day 7, animals were randomised to undergo deep hypothermic circulatory arrest or sham. Arterial oxygen tension and haematocrit were obtained. Neurobehavioural performance was serially assessed. The animals were sacrificed on day 14. Brain tissue was assessed for neuronal necrosis using a 5-point histopathologic score.

Results:

Four experimental groups were analysed (sham, n = 10; sham + deep hypothermic circulatory arrest, n = 8; shunt, n = 9; shunt + deep hypothermic circulatory arrest, n = 7). Cyanotic piglets had significantly higher haematocrit and lower partial pressure of oxygen at day 14 than non-cyanotic piglets. There were no statistically significant differences in neurobehavioural scores at day 1. However, shunt + deep hypothermic circulatory arrest piglets had evidence of greater neuronal injury than sham animals (median (range): 2 (0–4) versus 0 (0–0), p = 0.02).

Discussion:

Cyanotic piglets undergoing deep hypothermic circulatory arrest had increased neuronal injury compared to sham animals. Significant injury was not seen for either cyanosis or deep hypothermic circulatory arrest alone relative to shams. These findings suggest an interaction between cyanosis and deep hypothermic circulatory arrest and may partially explain the suboptimal neurologic outcomes seen in children with cyanotic heart disease who undergo deep hypothermic circulatory arrest.

Keywords

Hypoxiacardiopulmonary bypassanimal studydeep hypothermic circulatory arrest
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 769 - 774
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

These authors are first authors on this review with a shared first co-authorship.

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