Work

Preclinical 1 H MRS Study of a Porcine Model Shows Evidence and Mechanisms for Acute Neuronal Injury in Neonatal Cardiopulmonary Bypass ( CPB ) Surgery

Year: 2026

Type: article

Abstract: ABSTRACT Purpose Congenital heart disease affects 1% of US births, with some infants requiring cardiothoracic surgery under cardiopulmonary bypass (CPB). Optimal surgical parameters to minimize neuronal injury are unknown. We used serial 1 H MRS in a neonatal CPB porcine model to assess acute neuronal damage and associated injury mechanisms. Methods 2‐week‐old piglets ( N = 26) were placed in a 3 T MRI to study brain metabolism during CPB. Dynamic single‐voxel 1 H MRS brain data were acquired while animals underwent CPB via antegrade cerebral perfusion (ACP) or complete circulatory arrest (CA) with findings quantified via ratios to the average total creatine (tCr ave ). Hypothermic temperatures ranged between 18°C–37°C, and blood glucose (Glc) levels immediately prior to CA ranged from 54 to 700 mg/dL. Acute neuronal injury at ∼1 h post‐CA was assessed by decreased N‐acetyl aspartate (NAA) and correlated with three potential injury mechanisms: (1) energy failure via pre‐CA Glc and phosphocreatine (PCr) loss during CA, (2) reperfusion injury via elevated succinate (Suc) at end of CA, and (3) ammonia toxicity via post‐CA glutamine/glutamate (Gln/Glu) levels. Results A temperature‐dependent NAA/tCr ave decrease was observed for the CA studies, whereas no decreases were seen in the ACP animals. Multiple linear regression analysis revealed that NAA/tCr ave loss was significantly associated with pre‐CA brain Glc/tCr ( p = 0.001) and average PCr/tCr ave levels during CA ( p = 0.024). NAA/tCr ave losses were not significantly associated with Suc/tCr ave or Gln/Glu changes. Conclusions 1 H‐MRS in a CPB model identified neuronal injury ∼1 h post CA, with injury severity correlating with pre‐CA Glc/tCr ave levels and loss of PCr/tCr ave during CA.

Source: Magnetic Resonance in Medicine

DOI: 10.1002/mrm.70364

Authors: Aaron Omon, Meng Gu, Ralph Hurd, Kirk Riemer, Frank Hanley, Daniel Spielman

Institutions: Stanford Medicine, Stanford University

Language: English

Topic: Cardiac and Coronary Surgery Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,680