CARDIOVASCULAR
ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs

Volume 5, 2000, No 3

Neuropathophysiology in Hypothermic Cardiopulmonary Bypass
T. Fessatidis

Neurologic dysfunction following cardiac surgery, is a major cause of postoperative morbidity and mortality.
In order to reduce the impact of this complication perioperatively it is essential a) to define the nature and extent of the problem, b) to identify its aetiology, c) to test the appropriate therapies.
Three main aetiological factors are considered important in the brain damage syndromes associated with cardiac surgery:

  1. altered cerebral perfusion, particularly during hypothermic cardiopulmonary bypass (CPB),

  2. embolism within the cerebral circulation, 

  3. the inflammatory response to CPB.

In addition, many clinical and experimental studies have shown that arterial carbon dioxide pressure (PaCO2), temperature, haemodilution, flow-metabolism coupling, pressure-flow autoregulation, anaesthetic agents, are major factors that regulate cerebral blood flow (CBF) during hypothermic CPB.
Strategies that reduce the embolic load to the cerebral circulation, optimize cerebral cellular function by using pulsatile perfusion, and attenuate the inflammatory response to CPB, may prove particularly beneficial in reducing or preventing cerebral injury associated with cardiac surgery.

(CVE. 2000; 5 (3): 188-199)

Key words: cerebral injury, cardiopulmonary bypass, hypothermia

Ioannis Th. Fessatidis, M.D.
Consultant Cardiothoracic Surgeon
Cardiothoracic Surgery Department
George Papanikolaou General Hospital
GR-57010 Exohi, Thessaloniki
Greece

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