Retrograde cerebral perfusion with intermittent pressure augmentation provides adequate neuroprotection: Diffusion- and perfusion-weighted magnetic resonance.

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Retrograde cerebral perfusion with intermittent pressure augmentation provides adequate neuroprotection: Diffusion- and perfusion-weighted magnetic resonance imaging study in an experimental canine model Mitsuhiro Kawata, MD, Masaki Sekino, PhD, Shinichi Takamoto, MD, PhD, Shoogo Ueno, PhD, Sachiko Yamaguchi, MS, Kazuo Kitahori, MD, PhD, Hiroyuki Tsukihara, MD, Yoshihiro Suematsu, MD, PhD, Minoru Ono, MD, PhD, Noboru Motomura, MD, PhD, Tetsuro Morota, MD, PhD, Arata Murakami, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 4, Pages 933-940 (October 2006) DOI: 10.1016/j.jtcvs.2006.03.064 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Region of interest (ROI). : 1.5 × 1.5 mm2. PL, Parietal lobe; CV, cerebral ventricle; TL, temporal lobe; THA, thalamus; HIP, hippocampus; CA, circulatory arrest; DWI, diffusion-weighted magnetic resonance imaging; ASCP, antegrade selective cerebral perfusion; RCP-INT, retrograde cerebral perfusion with intermittent pressure augmentation; RCP-C, conventional retrograde cerebral perfusion; CPB, cardiopulmonary bypass; PWI, perfusion-weighted magnetic resonance imaging. The time points of the experimental procedure in each group are shown. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Apparent diffusion coefficient (ADC) map in the circulatory arrest group. a, Before surgery (36°C); b, on cardiopulmonary bypass (18°C); c, circulatory arrest (18°C). B, ADC map for comparison among the different cerebral protection methods. a, Antegrade selective cerebral perfusion; b, retrograde cerebral perfusion with intermittent pressure augmentation; c, conventional retrograde cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Apparent diffusion coefficient (ADC) values in the circulatory arrest (CA) group. HIP, Hippocampus; THA, thalamus; TL, temporal lobe; PL, parietal lobe; CV, cerebral ventricle (cerebrospinal fluid); CPB, cardiopulmonary bypass. B, Comparison of the ADC values among the different cerebral protection methods. ASCP, Antegrade selective cerebral perfusion; RCP-INT, retrograde cerebral perfusion with intermittent pressure augmentation; RCP-C, conventional retrograde cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Relative regional cerebral blood volume (rrCBV) map in the circulatory arrest group. a, Before surgery (36°C); b, on cardiopulmonary bypass (18°C). B, rrCBV map for comparison among the different cerebral protection methods. a, Antegrade selective cerebral perfusion; b, retrograde cerebral perfusion with intermittent pressure augmentation; c, conventional retrograde cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Relative regional cerebral blood volume (rrCBV) values in the circulatory arrest group. HIP, Hippocampus; THA, thalamus; TL, temporal lobe; PL, parietal lobe; CPB, cardiopulmonary bypass. B, Comparison of the rrCBV values among the different cerebral protection methods. ASCP, Antegrade selective cerebral perfusion; RCP-INT, retrograde cerebral perfusion with intermittent pressure augmentation; RCP-C, conventional retrograde cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Histopathologic Damage Score. The score was defined as follows: no damaged neurons (0), minimal (2), mild (4), moderate (6), or severe (8). HIP, Hippocampus; THA, thalamus; TL, temporal lobe; PL, parietal lobe; Total, total Histopathologic Damage Score; ASCP, antegrade selective cerebral perfusion; RCP-INT, retrograde cerebral perfusion with intermittent pressure augmentation; RCP-C, conventional retrograde cerebral perfusion; CA, circulatory arrest. The P values shown present the results of the post hoc Dunnett test versus the result in the RCP-INT group. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Sections of the hippocampus (stain, hematoxylin-eosin; original magnification, 200×). A, Antegrade selective cerebral perfusion group. B, Retrograde cerebral perfusion with intermittent pressure augmentation group. C, Conventional retrograde cerebral perfusion group. D, Circulatory arrest group. Minimal evidence of cellular damage is seen in A and B, whereas pyknotic nuclei, shrunken eosinophilic cytoplasm, and microvacuolization are seen in C and D. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 933-940DOI: (10.1016/j.jtcvs.2006.03.064) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions