Masahiro Ono, MD, PhD, Charles Brown, MD, Jennifer K

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Cerebral Blood Flow Autoregulation Is Preserved After Hypothermic Circulatory Arrest Masahiro Ono, MD, PhD, Charles Brown, MD, Jennifer K. Lee, MD, Rebecca F. Gottesman, MD, PhD, Michael Kraut, MD, PhD, James Black, MD, Ashish Shah, MD, Duke E. Cameron, MD, William Baumgartner, MD, Charles W. Hogue, MD The Annals of Thoracic Surgery Volume 96, Issue 6, Pages 2045-2053 (December 2013) DOI: 10.1016/j.athoracsur.2013.07.086 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Intraoperative cerebral oximetry index (COx) recording: (A) is the time line of arterial pressure and regional cerebral oxygen saturation and (D) is the percentage of time spent at each 5-mm Hg arterial blood pressure (ABP). (B): Left (L) and (C) right (R) COx represent the correlation between cerebral oxygen saturation and blood pressure. When blood pressure is outside the autoregulation limits, COx increases toward 1. The Annals of Thoracic Surgery 2013 96, 2045-2053DOI: (10.1016/j.athoracsur.2013.07.086) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Average cerebral oximetry index (COx) is shown for patients undergoing operations with cardiopulmonary bypass (CPB) with and without hypothermic circulatory arrest (HCA). The horizontal line in the middle of each box shows the median, the top and bottom borders of the box mark the interquartile range (25th and 75th percentile), and the whisker length represents the 1.5 interquartile range. The dashed line at COx = 0.3 indicates the threshold for defining impaired autoregulation. (Cooling = beginning of CPB to initiation of HCA or rewarming; pre-CPB = before initiation of CPB; rewarming = termination of HCA or beginning of rewarming to termination of CPB.) The Annals of Thoracic Surgery 2013 96, 2045-2053DOI: (10.1016/j.athoracsur.2013.07.086) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Average cerebral oximetry index (COx) for patients who underwent operations with cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA) with and without antegrade selective cerebral perfusion (SACP). The horizontal line in the middle of each box shows the median, the top and bottom borders of the box mark the interquartile range (25th and 75th percentile), and the whisker length represents the 1.5 interquartile range. Data points not included between the whiskers are plotted as an outlier with a dot. The dashed line at COx = 0.3 indicates the threshold for defining impaired autoregulation. (Cooling = beginning of CPB to initiation of HCA or rewarming; pre-CPB = before initiation of CPB; rewarming = termination of HCA or beginning of rewarming to termination of CPB.) The Annals of Thoracic Surgery 2013 96, 2045-2053DOI: (10.1016/j.athoracsur.2013.07.086) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The lower limit of autoregulation (LLA) was compared for patients undergoing operations with cardiopulmonary bypass (CPB) with and without hypothermic circulatory arrest (HCA). The horizontal line in the middle of each box shows the median, the top and bottom borders of the box mark the interquartile range (25th and 75th percentile), and the whisker length represents the 1.5 interquartile range. Data points not included between the whiskers are plotted as an outlier with a dot. (Cooling = beginning of CPB to initiation of HCA or rewarming; pre-CPB = before initiation of CPB; rewarming = termination of HCA or beginning of rewarming to termination of CPB.) The Annals of Thoracic Surgery 2013 96, 2045-2053DOI: (10.1016/j.athoracsur.2013.07.086) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions