Mavroudis 2018 Eur J Cardiothorac Surg
|Mavroudis CD, Karlsson M, Ko T, Hefti M, Gentile JI, Morgan RW, Plyler R, Mensah-Brown KG, Boorady TW, Melchior RW, Rosenthal TM, Shade BC, Schiavo KL, Nicolson SC, Spray TL, Sutton RM, Berg RA, Licht DJ, Gaynor JW, Kilbaugh TJ (2018) Cerebral mitochondrial dysfunction associated with deep hypothermic circulatory arrest in neonatal swine. Eur J Cardiothorac Surg 54:162-68.|
Mavroudis CD, Karlsson M, Ko T, Hefti M, Gentile JI, Morgan RW, Plyler R, Mensah-Brown KG, Boorady TW, Melchior RW, Rosenthal TM, Shade BC, Schiavo KL, Nicolson SC, Spray TL, Sutton RM, Berg RA, Licht DJ, Gaynor JW, Kilbaugh TJ (2018) Eur J Cardiothorac Surg
Abstract: Controversy remains regarding the use of deep hypothermic circulatory arrest (DHCA) in neonatal cardiac surgery. Alterations in cerebral mitochondrial bioenergetics are thought to contribute to ischaemia-reperfusion injury in DHCA. The purpose of this study was to compare cerebral mitochondrial bioenergetics for DHCA with deep hypothermic continuous perfusion using a neonatal swine model.
Twenty-four piglets (mean weight 3.8 kg) were placed on cardiopulmonary bypass (CPB): 10 underwent 40-min DHCA, following cooling to 18°C, 10 underwent 40 min DHCA and 10 remained at deep hypothermia for 40 min; animals were subsequently rewarmed to normothermia. 4 remained on normothermic CPB throughout. Fresh brain tissue was harvested while on CPB and assessed for mitochondrial respiration and reactive oxygen species generation. Cerebral microdialysis samples were collected throughout the analysis.
DHCA animals had significantly decreased mitochondrial complex I respiration, maximal oxidative phosphorylation, respiratory control ratio and significantly increased mitochondrial reactive oxygen species (P < 0.05 for all). DHCA animals also had significantly increased cerebral microdialysis indicators of cerebral ischaemia (lactate/pyruvate ratio) and neuronal death (glycerol) during and after rewarming.
DHCA is associated with disruption of mitochondrial bioenergetics compared with deep hypothermic continuous perfusion. Preserving mitochondrial health may mitigate brain injury in cardiac surgical patients. Further studies are needed to better understand the mechanisms of neurological injury in neonatal cardiac surgery and correlate mitochondrial dysfunction with neurological outcomes.
• Keywords: Basic science, Congenital heart surgery, Deep hypothermic circulatory arrest, Mitochondria, Neuroprotection • Bioblast editor: Kandolf G • O2k-Network Lab: SE Lund Elmer E, US PA Philadelphia Margulies S
Labels: MiParea: Respiration
Stress:Ischemia-reperfusion, Temperature Organism: Pig Tissue;cell: Nervous system Preparation: Homogenate
Coupling state: LEAK, OXPHOS, ET Pathway: N, S, CIV, NS, ROX HRR: Oxygraph-2k, O2k-Fluorometer