Preliminary results of intermittent retrograde cerebral perfusion during proximal aortic arch surgery

Retrograde cerebral perfusion of oxygenated, compacted red blood cells attenuates brain damage after hypothermia circulation arrest of rat

BACKGROUND

It was proved that higher haematocrit (Hct) might improve the function of brain after hypothermia circulation arrest (HCA). In the present study we established a new rat HCA model and investigated whether retrograde cerebral perfusion of oxygenated, compacted red blood cells (RBC) could attenuate brain injury after HCA.

METHODS

A new rat HCA model was developed and rats were randomly distributed into three groups: HCA group, HCA combined with retrograde cerebral perfusion of oxygenated, compacted red blood cell group (HCArcp group), and sham operation group (sham op. group). Animals both in the HCA group and in the HCArcp group underwent HCA 90 min at 18 degrees C. Brain damage after HCA was evaluated with light microscopy and electron microscopy. Immunohistochemistry and RT-PCR techniques were used to measured the different expressions of the C-Fos, Bcl-2, Bax mRNA and protein among the groups. Additionally we measured the wet/dry ratio of the brain in order to evaluate the oedema degree after HCA.

RESULTS

The new HCA model of rat we developed was comparable to the clinical setting not only in terms of the intubation, anaesthesia method and materials employed but also in terms of the priming volume in relation to body weight. The number of injured neurones in the hippocampus CA1 and parietal cortex, but not in the thalamus of the HCA group, was significantly greater than that of the HCArcp group (P<0.05). The mean score of mitochondrion of the hippocampus CA1 in the HCA group was significantly higher than in the HCArcp group (P<0.05). The expression of C-Fos, Bax mRNA and protein in the hippocampus CA1 and/or parietal cortex area was higher in the HCA group than in the HCArcp group (P<0.05). Expression of the mRNA and protein of Bcl-2 was higher in the HCArcp group than in the HCA group (P<0.05). The degree of oedema after HCA between the HCA group and HCArcp group had no significant difference (P>0.05).

CONCLUSIONS

We established a new rat model of HCA comparable to the clinical setting. Retrograde cerebral perfusion of oxygenated, compacted RBC is a simple, effective, and safe method to protect the brain during HCA. Adjusting the gene expression in relation to apoptosis might contribute to the neuroprotective effects of a retrograde cerebral infusion of oxygenated, compacted RBC.