Establishment of antegrade selective cerebral perfusion during aortic arch operation

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Objective : Patients with old cerebral infarction who undergo aortic arch operation are more susceptible to postoperative neurological dysfunction. To verify such susceptibility, this experimental study was performed. Methods : Cerebral infarct model was created in mongrel dogs by injection of cylindrical silicon embolus through the internal carotid artery. The dogs that had obvious neurological deficits one day later and survived for 4 weeks or more were included in the cerebral infarct model. One month after cerebral infarction was induced, deep hypothermia and selective cerebral perfusion were employed in fourteen mongrel dogs (Infarct group 7, Control group 7). During this procedure, serum glutamate concentration and venous-arterial lactate difference were measured. Histopathological study of the brain was also performed. Results : Changes in venous-arterial lactate difference in both groups were almost similar except in rewarming phase. At 32℃ during rewarming, venous-arterial lactate difference in the Infarct group was significantly higher than that in the Control group (p=0.006). Although pre-cooling concentrations of serum glutamate were similar in both groups, the values in the Infarct group at the end of rewarming were significantly higher than those in the Control group (p=0.046). On histological examinations, the presence of old cerebral infarction with gliosis was confirmed in the Infarct group but neither new cerebral infarction nor destruction of blood brain barrier was found. Conclusion : We have observed an accelerated anaerobic metabolism and an increased extracellular glutamate release in the Infarct group. The brain with old cerebral infarction is more susceptible to ischemia during arch operation.