Perfusion related parameters affecting cerebral outcome after cardiac surgery

Abstract

The necessity to perform cardiopulmonary bypass (CPB) which permits open cardiac surgery has been considered one of the most significant medical developments of the 20th century. From animal laboratory experiments by physiologists more than 150 years ago to the clinical applications in the early 1950s, open-heart surgery with CPB has grown to the extent that more than 700 hospitals in the United States perform approximately 350,000 CPB procedures each year. Whereas congenital or valvular surgery predominated the early CPB experience, the advent of the coronary artery bypass graft (CABG) operation in the early 1970s has been largely responsible for the extraordinary growth in the number of cases. Despite a trend in recent years towards percutaneous transluminal coronary angioplasty (PTCA) procedures by cardiologists to treat coronary artery disease (which does not require use of CPB) the CABG operation remains the most frequent requirement for CPB today. The fact that many of these patients are middle-aged and actively employed further emphasizes the need for optimum cerebral protection during CPB.