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Hypothermic circulatory arrest increases permeability of the blood brain barrier in watershed areas

Toru Okamura1, Nobuyuki Ishibashi, T Susheel Kumar

  • 1Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA.

The Annals of Thoracic Surgery
|November 25, 2010
PubMed

Insights

Hypothermic circulatory arrest (HCA) at 25°C impairs the blood-brain barrier (BBB) in piglets, particularly in watershed areas. This BBB disruption may contribute to brain damage following cardiopulmonary bypass (CPB).

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Surgery
  • Neuroscience

Background:

  • The integrity of the blood-brain barrier (BBB) following cardiopulmonary bypass (CPB) with hypothermic circulatory arrest (HCA) in pediatric patients remains a subject of debate.
  • This study investigated the impact of HCA on BBB integrity.

Purpose of the Study:

  • To test the hypothesis that HCA disrupts the BBB.
  • To evaluate the effect of different HCA temperatures on BBB integrity.

Main Methods:

  • Forty-one piglets underwent acute and survival studies involving CPB with varying temperatures and flow rates, including HCA at 15°C and 25°C.
  • Blood-brain barrier integrity was assessed using Evans blue dye (EBD) extravasation and immunohistochemical analysis of albumin.
  • Cerebral histology was evaluated in survival studies.

Main Results:

  • Significant BBB disruption was observed around watershed areas in piglets subjected to HCA at 25°C.
  • Microscopic analysis confirmed more severe EBD leakage and albumin extravasation in the 25°C HCA group compared to controls.
  • Histologic damage scores were elevated in watershed areas following 25°C HCA.

Conclusions:

  • HCA at 25°C for 1 hour impairs the BBB around watershed areas, as evidenced by both macroscopic and microscopic findings.
  • Increased BBB permeability is suggested to be both an indicator and a contributing factor to brain damage.
Abstract

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