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Ann Thorac Surg 2010;89:187-194. doi:10.1016/j.athoracsur.2009.09.030
© 2010 The Society of Thoracic Surgeons
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Toru Okamura
Nobuyuki Ishibashi
Richard A. Jonas
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Original Articles: Pediatric Cardiac

Cardiopulmonary Bypass Increases Permeability of the Blood-Cerebrospinal Fluid Barrier

Toru Okamura, MD, Nobuyuki Ishibashi, MD, David Zurakowski, PhD, Richard A. Jonas, MD*

Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC

Accepted for publication September 14, 2009.

* Address correspondence to Dr Jonas, Department of Cardiac Surgery, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (Email: rjonas{at}cnmc.org).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: The integrity of the blood-cerebrospinal fluid (CSF) barrier during cardiopulmonary bypass (CPB) with hypothermic circulatory arrest (HCA) has not been systematically studied, especially in children. We tested the hypothesis that the blood-CSF barrier is disrupted by CPB.

Methods: The study randomized 25 piglets (mean weight, 11 kg) to five groups (5 per group): anesthesia alone (control); CPB at 37°C with full-flow (FF); CPB at 25°C with very low flow (LF); and HCA at 15°C and 25°C. pH-stat strategy was applied during CPB. An epidural catheter was inserted into the cisterna magna for collection of CSF. CSF and blood samples were collected at seven points: after induction of anesthesia (baseline), at 10, 50 and 115 minutes after start of CPB, just before the end of CPB, and at 30 and 120 minutes after CPB. Albumin levels in CSF and plasma were measured to assess blood-CSF barrier integrity and the albumin ratio (CSF/plasma) was calculated (Q Alb).

Results: In both HCA groups, the Q Alb was significantly higher than in the control and 37°C FF groups (all p < 0.05), whereas Q Alb in the 37°C group was not significantly different vs control.

Conclusions: The blood-CSF barrier is impaired by CPB with 1 hour of 15°C or 25°C HCA. Further investigations are needed to understand the behavior of the blood-CSF barrier during CPB and its role in neuroprotection.






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