Brain injury in cardiopulmonary bypass

Fabio Ramponi, Kay Hon, Michael Seco, Jonathon Paul Fanning, Paul G. Bannon, Leonard Kritharides, John D. Puskas, Michael P. Vallely

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Although the use of cardiopulmonary bypass has become routine in modern cardiac surgery, its application exposes the body to a nonphysiological state with inevitable pernicious consequences on multiple organs. Preservation of intact brain function after cardiac surgery is of utmost importance for the surgeon and postoperative cerebral integrity often represents the chief concern for the patient as well. Extracorporeal circulation is responsible for potential neurologic injury via multiple mechanisms including embolization in the cerebral circulation, systemic inflammatory response mediated by cytokines, and ischemia-reperfusion pathway mediated by free radicals. Even though overt brain injury in the form of clinical stroke is overall a rare event, up to 40% of patients undergoing cardiac surgery on cardiopulmonary bypass show evidence of perioperative covert neurologic injury on diffusion-weighted magnetic resonance imaging, a finding of absolute clinical significance for a full recovery. Over the last four decades different strategies have been implemented to mitigate the neurologic insult associated with cardiopulmonary bypass and enhance brain recovery after extracorporeal circulation. Despite an overall improvement in clinical results, complete avoidance of both cardiopulmonary bypass and aortic manipulation appears to provide the best neurologic outcome.

Original languageEnglish
Title of host publicationCardiopulmonary Bypass
Subtitle of host publicationAdvances in Extracorporeal Life Support
PublisherElsevier
Pages659-673
Number of pages15
ISBN (Electronic)9780443189180
DOIs
StatePublished - 1 Jan 2022
Externally publishedYes

Keywords

  • Cardiopulmonary bypass
  • cerebral hypoperfusion
  • cerebral injury
  • embolism
  • inflammation
  • stroke

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