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Arterial line filtration protects brain microcirculation during cardiopulmonary bypass in the pig
J Waaben1, H R Sørensen, U L Andersen
1Institute of Experimental Pathology, Rigshospitalet, Copenhagen, Denmark.
Abstract:
Microemboli in the brain may inhibit brain function during cardiopulmonary bypass, and in a previous study in pigs of normothermic nonpulsatile bypass we reported a significant decrease in cerebral glucose consumption secondary to interruption of the capillary flow, possibly caused by microemboli. In the present study we measured the regional cerebral glucose consumption and the regional capillary diffusion capacity (that is, the number of perfused capillaries) in 10 different brain regions in two separate groups of animals with and without an arterial filter during normothermic cardiopulmonary bypass. Inclusion of a 40 micron arterial filter in the bypass circuit increased the regional brain glucose consumption 27% (median; range -12% to 145%) and regional capillary diffusion capacity increased 123% (median; range 36% to 829%). No change in brain histologic features, the cerebrovascular permeability to serum proteins, or cerebral water content was observed. The arterial filter probably protects the cerebral microcirculation and prevents the decrease in cerebral glucose consumption otherwise seen during bypass.
Insights
Using an arterial filter during cardiopulmonary bypass (CPB) significantly improved brain function by increasing cerebral glucose consumption and capillary perfusion. This suggests filters protect the brain microcirculation during CPB.
Area of Science:
- Neuroscience
- Cardiovascular Surgery
- Medical Devices
Background:
- Microemboli during cardiopulmonary bypass (CPB) can impair brain function.
- Previous studies indicated reduced cerebral glucose consumption during CPB due to microemboli-induced capillary flow interruption.
Purpose of the Study:
- To investigate the effect of an arterial filter on regional cerebral glucose consumption and capillary diffusion capacity during normothermic CPB.
- To determine if an arterial filter mitigates the negative impact of CPB on brain microcirculation.
Main Methods:
- Two groups of pigs underwent normothermic CPB, one with a 40-micron arterial filter and one without.
- Regional cerebral glucose consumption and capillary diffusion capacity were measured in 10 brain regions.
- Histologic features, cerebrovascular permeability, and cerebral water content were assessed.
Main Results:
- Inclusion of an arterial filter increased median regional brain glucose consumption by 27% and median regional capillary diffusion capacity by 123%.
- No adverse changes in brain histology, protein permeability, or water content were observed with the filter.
- The arterial filter prevented the decrease in cerebral glucose consumption seen in the control group.
Conclusions:
- A 40-micron arterial filter effectively protects the cerebral microcirculation during normothermic cardiopulmonary bypass.
- Arterial filtration preserves cerebral glucose metabolism and capillary perfusion, suggesting improved brain function during CPB.