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Eur J Cardiothorac Surg 2009;36:426. doi:10.1016/j.ejcts.2009.04.008
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Reply to Khaladj et al.

Yuji Miyamoto*, Shinya Fukui, Tetsuya Kajiyama, Masataka Mituno

Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan

Received 4 April 2009; accepted 6 April 2009.

* Corresponding author. Tel.: +81 798 45 6852; fax: +81 798 45 6853. (Email: y-miyamo{at}hyo-med.ac.jp).

Key Words: Selective cerebral perfusion • Collateral blood flow • Tissue blood flow

We thank Dr Khaladj et al. [1] for their interest and comments regarding our article. We agree to their opinion that a three-vessel perfusion is important in a patient with incomplete circle of Willis concerning brain protection. We intentionally cited only a few papers concerning brain protection during selective cerebral perfusion (SCP), because the focus in this article was on lower body perfusion during SCP.

We have the data of near-infrared spectroscopy regarding brain perfusion during two- or three-vessel SCP. However, the duration of two-vessel perfusion was 1 min; therefore, there was no difference between the various perfusion techniques. In this article, brain protection was not the point of focus anyway. We completely agree that a core temperature of 20 °C may not be necessary with regard to lower body protection. The safe time limit to prevent lower body ischaemia at 25–28 °C is empirically recognised as 60 min [2]. However, this study was performed at 20 °C because we believe that the lower the temperature, the safer the whole body is.

The interpretation of the amount of collateral blood flow (CBF) is the most important. We think this point may have been misunderstood. Your letter mentioned that CBF seemed to be negligible since it was only 6.5% of the total SCP flow. This measured CBF did not mean the amount of the perfusion to the lower body. The measured CBF may flow solely into the descending aorta through arterioles. CBF flowing into the visceral organs through arterioles and capillaries is the real perfusion of end-organs; this real CBF returns into the inferior vena cava, but its amount cannot be measured directly. We measured only the amount of returning blood into the descending aorta.

The understanding of tissue blood flow during SCP is another important issue. We have proved that real perfusion to the visceral organs through CBF existed during SCP while there was no active perfusion to the lower body. This tissue blood flow is a measure of the surface flow of an organ [3]. The absolute value of this measurement may not have any correlation with total flows in the organ. There was in fact no correlation between the measured CBF and tissue blood flow; however, we think this is quite reasonable from the two reasons mentioned above.

References

  1. Khaladj N, Peterss S, Haverich A, Hagl C. Selective antegrade three vessel cerebral perfusion: A technique to protect the brain and lower body?. Eur J Cardiothorac Surg 2009;36:425-426.[Free Full Text]
  2. Pacini D, Leone A, Marco LD, Marsilli D, Sobaih F, Turci S, Masieri V, Bartolomeo RD. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg 2007;31:618-622.[Abstract/Free Full Text]
  3. Kashimka S. Non-contact laser tissue blood flow measurement using polarization to reduce the specular reflection artifact. Opt Laser Technol 1994;26:169-175.[CrossRef]




This Article
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Yuji Miyamoto
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Right arrow Articles by Miyamoto, Y.
Right arrow Articles by Mituno, M.
Related Collections
Right arrow Cerebral protection
Right arrow Extracorporeal circulation
Right arrow Great vessels

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