Effect of Deep Hypothermia on Cerebral Hemodynamics during Selective Cerebral Perfusion with Systemic Circulatory Arrest

Objective: We studied the effect of deep hypothermia on cerebral hemodynamics during selective cerebral perfusion with systemic circulatory arrest. Methods: Ten anesthesized pigs were placed on cardiopulmonary bypass and cooled to a rectal temperature of 22°C (n = 5) or 15°C (n = 5). During selective cerebral perfusion, the descending aorta was clamped and perfusion of the lower body was discontinued. As the pump flow was changed, we monitored the perfusion pressure, local cerebral blood flow, and local cerebral oxygenation using laser Doppler flowmetry and near-infrared spectroscopy. We also measured the free flow of the left internal thoracic artery during selective cerebral perfusion. Results: Perfusion pressure and local cerebral blood flow decreased as the pump flow decreased. Oxygenated and deoxygenated hemoglobin in cerebral tissue remained unchanged at a perfusion flow of 10 ml/kg/min, whereas oxygenated hemoglobin decreased and deoxygenated hemoglobin increased progressively and reciprocally as the pump flow decreased. The pump flow for maintaining perfusion pressure above 35 mmHg with stabilized local cerebral oxygenation was significantly higher at 15°C than at 22°C. The internal thoracic artery free flow was higher at 15°C than at 22°C. Conclusions: Selective hypothermic cerebral perfusion with systemic circulatory arrest produces an extracranial shunt through the internal thoracic artery, especially under deep hypothermia. Our data suggests that selective cerebral perfusion during deep hypothermia is best managed by perfusion pressure control rather than by flow control.