Antegrade cerebral perfusion reduces apoptotic neuronal injury in a neonatal piglet model of cardiopulmonary bypass
Antegrade cerebral perfusion reduces apoptotic neuronal injury in a neonatal piglet model of cardiopulmonary bypass
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DOI：
10.1016/j.jtcvs.2005.09.005
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发表时间：
2006-03-01
影响因子：
6
通讯作者：
Reddy, VM
中科院分区：
文献类型：
--
作者：
Chock, VY;Amir, G;Reddy, VM
目的：患有先天性心脏病的新生儿可能需要深低温停循环手术修复，这是一种与不良神经发育结局相关的技术。尽管没有支持的实验数据，但顺行脑灌注被认为可以最大限度地减少缺血性脑损伤。我们试图评估和比较深低温停循环和顺行脑perfusion.Methods新生仔猪模型的神经损伤程度：新生仔猪接受心肺转流术随机深低温停循环或顺行脑灌注45分钟。恢复6小时后处死动物，并对脑组织进行染色，以获得细胞损伤的证据和凋亡标志物激活的半胱天冬酶3和细胞色素c从线粒体易位到胞质sol.Results：顺行脑灌注组的仔猪表现出较少的凋亡或坏死损伤（4 +/- 3 vs 29 +/- 12个细胞/视野，P = 0.03）。接受顺行脑灌注的小猪也有较少的凋亡证据，活化的半胱天冬酶3染色的细胞较少（57 +/- 8 vs 93 +/- 9个细胞/视野，P = .001）或显示细胞色素c易位（6 +/- 2 vs 15 +/- 4个细胞/视野，P = 0.02）.结论：使用顺行脑灌注代替深低温停循环减少了新生仔猪细胞凋亡和组织损伤的证据。先天性心脏病的新生儿在复杂的心脏手术中可能受益于顺行脑灌注，以改善其整体神经功能结局。
Objective: Neonates with congenital heart disease might require surgical repair with deep hypothermic circulatory arrest, a technique associated with adverse neurodevelopmental outcomes. Antegrade cerebral perfusion is thought to minimize ischemic brain injury, although there are no supporting experimental data. We sought to evaluate and compare the extent of neurologic injury in a neonatal piglet model of deep hypothermic circulatory arrest and antegrade cerebral perfusion.Methods: Neonatal piglets undergoing cardiopulmonary bypass were randomized to deep hypothermic circulatory arrest or antegrade cerebral perfusion for 45 minutes. Animals were killed after 6 hours of recovery, and brain tissue was stained for evidence of cellular injury and for the apoptotic markers activated caspase 3 and cytochrome c translocation from mitochondria to cytosol.Results: Piglets from the antegrade cerebral perfusion group exhibited less apoptotic or necrotic injury ( 4 +/- 3 vs 29 +/- 12 cells per field, P = .03). The piglets undergoing antegrade cerebral perfusion also had less evidence of apoptosis, with fewer cells staining for activated caspase 3 ( 57 +/- 8 vs 93 +/- 9 cells per field, P = .001) or showing cytochrome c translocation ( 6 +/- 2 vs 15 +/- 4 cells per field, P = .02).Conclusions: The use of antegrade cerebral perfusion in place of deep hypothermic circulatory arrest reduces evidence of apoptosis and histologic injury in neonatal piglets. Neonates with congenital heart disease might benefit from antegrade cerebral perfusion during complex cardiac surgery to improve their overall neurologic outcome.