The role of cardiopulmonary bypass technique in cerebral protection

  • Christopher Blauth
Conference paper


Cardiopulmonary bypass is neccessary for most operations on the thoracic aorta, and optional for some cerebrovascular operations. In this context it is probable that the contribution of the bypass circuit itself to cerebral injury is small compared to the intrinsic risks imposed by the arterial pathology being treated. Particular patient related hazards for the brain include aortic atherosclerosis, flow limiting stenoses in extracranial and intra-cranial cerebral arteries, and previous cerebral infarcts.


Cerebral Blood Flow Cardiopulmonary Bypass Cerebral Injury Cerebral Protection Aortic Atherosclerosis 
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  1. 1.
    Kirklin JW, Barratt-Boyes BG (1993) Cardiac Surgery, 2nd Edition, Churchill Livingstone, New York, pp 89–91Google Scholar
  2. 2.
    Edmunds LH (1982) Pulseless cardiopulmonary bypass. J Thorac Cardiovasc Surg 84: 800–804PubMedGoogle Scholar
  3. 3.
    Craver JM, Bufkin BL, Weintraub WS, Guyton RA (1995) Neurologic events after coronary bypass grafting: further observations with warm cardioplegia. Ann Thorac Surg 59: 1429–1434PubMedCrossRefGoogle Scholar
  4. 4.
    Wareing TH, Davila-Roman VG, Barzilai B, Murphy SF, Kouchoukos NT (1992) Management of the severely atherosclerotic ascending aorta during cardiac operations: a strategy for detection and treatment. J Thorac Cardiovasc Surg 103: 453–462PubMedGoogle Scholar
  5. 5.
    Blauth CI, Cosgrove DM, Webb BW, Ratliff NB, Boylan M, Piedmonte MR, Lytle BW, Loop FD (1992) Atheroembolism from the ascending aorta. J Thorac Cardiovasc Surg 103: 1104–1112PubMedGoogle Scholar
  6. 6.
    Blauth CI (1995) Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 59: 1300–1303PubMedCrossRefGoogle Scholar
  7. 7.
    Johnston WE, Stump DA, DeWitt DS, Vinten-Johansen J, O’Steen WK, James RL, Prough DS (1993) Significance of gaseous microemboli in the cerebral circulation during cardiopulmonary bypass in dogs. Circulation 88: II 319–329Google Scholar
  8. 8.
    Moody DM, Bell MA, Challa VR, Johnston WE, Prough DS (1990) Brain microemboli during cardiac surgery or aortography. Ann Neurol 28: 477–486PubMedCrossRefGoogle Scholar
  9. 9.
    Padayachee TS, Parsons S, Theobold R, Linley J, Gosling RG, Deverall PB (1987) The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators. Ann Thorac Surg 44: 298–302PubMedCrossRefGoogle Scholar
  10. 10.
    Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S (1994) The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke 25: 1393–1399PubMedCrossRefGoogle Scholar
  11. 11.
    Blauth C, Smith PL, Arnold JV, Jagoe JR, Wootton R, Taylor KM (1990) Influence of oxygenator type on the incidence and extent of microembolic retinal ischaemia during cardiopulmonary bypass. Assessment by digital image analysis. J Thorac Cardiovasc Surg 99: 61–69PubMedGoogle Scholar
  12. 12.
    Schell RM, Kern FH, Greeley WJ, Schulman SR, Frasco PE, Croughwell ND, Newman M, Reves JG (1993) Cerebral blood flow and metabolism during cardiopulmonary bypass. Anesthesia and Analgesia 76: 849–865PubMedCrossRefGoogle Scholar
  13. 13.
    Schwartz AE, Sandhu AA, Kaplon RJ, Ypung WL, Jonassen AE, Adams DC, Edwards NM, Sistino JJ, Kwiatkowski P, Michler RE (1995) Cerebral blood flow is determined by arterial line pressure and not cardiopulmonary bypass flow rate. Ann Thorac Surg 60: 165–170PubMedGoogle Scholar
  14. 14.
    Venn GE, Patel RL, Chambers DJ (1995) Cardiopulmonary bypass: perioperative cerebral blood flow and postoperative cognitive deficit. Ann Thorac Surg 59: 1331–1335PubMedCrossRefGoogle Scholar
  15. 15.
    Dexter F, Hindman BJ (1995) Theoretical analysis of cerebral venous blood hemoglobin oxygen saturation as an index of cerebral oxygenation during hypothermic cardiopulmonary bypass. A counterproposal to the “luxury perfusion” hypothesis. Anesthesiology 83: 405–412PubMedCrossRefGoogle Scholar
  16. 16.
    Newman S (1995) Analysis and interpretation of neuropsychologic tests in cardiac surgery. Ann Thor Surg 59: 1351–1355CrossRefGoogle Scholar
  17. 17.
    Toner I, Peden CJ, Hamid SK, Newman S, Taylor KM, Smith PL (1994) Magnetic resonance imaging and neuropsychological changes after coronary artery bypass graft surgery: preliminary findings. J Neurosurg Anesthesiol 6: 163–169PubMedGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 1997

Authors and Affiliations

  • Christopher Blauth
    • 1
  1. 1.Department of Cardiothoracic SurgeryGuy’s and St. Thomas’ HospitalsLondonEngland

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