HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank W. Sellke Alon Stamler Robert G. Johnson William E. Cohn Ronald M. Weintraub Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sellke, F. W. Articles by Weintraub, R. M. Search for Related Content PubMed PubMed Citation Articles by Sellke, F. W. Articles by Weintraub, R. M.

J Thorac Cardiovasc Surg 1996;112:450-461
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

CARDIOPULMONARY BYPASS,
MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES
CHANGES IN AUTONOMIC RESPONSE OF THE CEREBRAL CIRCULATION AFTER NORMOTHERMIC EXTRACORPOREAL CIRCULATION

Supported by NIH grant HL 46716 and a grant from the American Heart Association, Massachusetts Affiliate.

Received for publication July 26, 1995 Accepted for publication Oct. 3, 1995. Address for reprints: Frank W. Sellke, MD, Division of Cardiothoracic Surgery, Beth Israel Hospital, Dana 905, 330 Brookline Ave., Boston, MA 02215.

Abstract

Patients who undergo cardiopulmonary bypass frequently have neuropsychologic dysfunction. This study was undertaken to determine whether altered cerebral perfusion and vascular responses may in part lead to these neuropsychologic changes. Pigs were placed on normothermic cardiopulmonary bypass for 2 hours. Basal cerebral blood flow and in vivo responses to administration by internal carotid artery of neuronally released vasoactive substances were evaluated before and 5 to 15 minutes after termination of cardiopulmonary bypass. Another group of pigs were placed on cardiopulmonary bypass for 2 hours and then perfused off bypass for 1 additional hour. In vitro responses of cerebral arterial microvessels (100 to 175µm) from both groups were examined in a pressurized (40 mm Hg) no-flow state with videomicroscopy. Vessels from uninstrumented pigs served as control preparations for in vitro studies. Cerebrovascular resistance and cerebral perfusion were maintained constant during cardiopulmonary bypass and after separation from bypass. The internal carotid artery infusion of acetylcholine (cholinergic agonist) caused increased internal carotid artery blood flow before cardiopulmonary bypass but decreased blood flow after cardiopulmonary bypass. After 2 hours of cardiopulmonary bypass, the increase in internal carotid artery blood flow induced by isoproterenol (aß-adrenoceptor agonist) was reduced, whereas the response to sodium nitroprusside (a guanylate cyclase activator) was unchanged. In vitro acetylcholine-induced microvascular vasodilation was converted to a contractile response and isoproterenol elicited less relaxation after 2 hours of cardiopulmonary bypass. One hour of cerebral perfusion after cardiopulmonary bypass caused a further reduction in isoproterenol-induced relaxation but had no further effect on the cholinergically mediated response. In vitro relaxation responses to sodium nitroprusside and forskolin (an adenylate cyclase activator) were similar in all experimental groups, suggesting that second-messenger mechanisms remain intact after normothermic cardiopulmonary bypass. In conclusion, basal cerebrovascular resistance and internal carotid artery blood flow are maintained if the systemic circulation and pressure are supported with fluid administration after cardiopulmonary bypass. Agonist-induced vasodilation of cerebral microvessels to cholinergic andß-adrenoceptor stimulation are selectively impaired after normothermic cardiopulmonary bypass, whereas second-messenger mechanisms remain intact. (J THORACCARDIOVASCSURG1996;112:450-61)

This article has been cited by other articles:

				M Buyukates, S Acikgoz, O Kandemir, E Aktunc, E Ceylan, and M Can Use of warm priming solution in open heart surgery: its effects on hemodynamics and acute inflammation Perfusion, March 1, 2008; 23(2): 89 - 94. [Abstract] [PDF]

				T. Modine, R. Azzaoui, T. Ouk, G. Fayad, D. Lacroix, H. Warembourg, R. Bordet, and T. Gourlay Changes in Cerebral Vascular Reactivity Occur Early During Cardiopulmonary Bypass in the Rat Ann. Thorac. Surg., August 1, 2006; 82(2): 672 - 678. [Abstract] [Full Text] [PDF]

				A. K. Srinivasan, M. J. Shackcloth, A. D. Grayson, and B. M. Fabri Preoperative {beta}-blocker therapy in coronary artery bypass surgery: a propensity score analysis of outcomes Interactive CardioVascular and Thoracic Surgery, December 1, 2003; 2(4): 495 - 500. [Abstract] [Full Text] [PDF]

				R Tosson, D Buchwald, K Klak, and A Laczkovics The impact of normothermia on the outcome of aortic valve surgery Perfusion, July 1, 2001; 16(4): 319 - 324. [Abstract] [PDF]

				W. A. Cooper, I. G. Duarte, V. H. Thourani, M. Nakamura, N.-P. Wang, W. M. Brown III, J. P. Gott, J. Vinten-Johansen, and R. A. Guyton Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis Ann. Thorac. Surg., March 1, 2000; 69(3): 696 - 702. [Abstract] [Full Text] [PDF]

				M. Tofukuji, C. Metais, C. D. Collard, D. S. Morse, G. L. Stahl, D. P. Nelson, J. Li, M. Simons, and F. W. Sellke Effect of sialyl Lewisx oligosaccharide on myocardial and cerebral injury in the pig Ann. Thorac. Surg., January 1, 1999; 67(1): 112 - 119. [Abstract] [Full Text] [PDF]

				A. Stamler, S. Y. Wang, D. E. Aguirre, R. G. Johnson, and F. W. Sellke Cardiopulmonary Bypass Alters Vasomotor Regulation of the Skeletal Muscle Microcirculation Ann. Thorac. Surg., August 1, 1997; 64(2): 460 - 465. [Abstract] [Full Text]

				S. Y. Wang, A. Stamler, M. Tofukuji, T. E. Deuson, and F. W. Sellke Effects of Blood and Crystalloid Cardioplegia on Adrenergic and Myogenic Vascular Mechanisms Ann. Thorac. Surg., January 1, 1997; 63(1): 41 - 49. [Abstract] [Full Text]