title: Pathophysiology of Cardiopulmonary Bypass: Current Strategies for the Prevention and Treatment of Anemia, Coagulopathy, and Organ Dysfunction.
abstract: The techniques and equipment of cardiopulmonary bypass (CPB) have evolved over the past 60 years, and numerous numbers of cardiac surgical procedures are conducted around the world using CPB. Despite more widespread applications of percutaneous coronary and valvular interventions, the need for cardiac surgery using CPB remains the standard approach for certain cardiac pathologies because some patients are ineligible for percutaneous procedures, or such procedures are unsuccessful in some. The ageing patient population for cardiac surgery poses a number of clinical challenges, including anemia, decreased cardiopulmonary reserve, chronic antithrombotic therapy, neurocognitive dysfunction, and renal insufficiency. The use of CPB is associated with inductions of systemic inflammatory responses involving both cellular and humoral interactions. Inflammatory pathways are complex and redundant, and thus, the reactions can be profoundly amplified to produce a multiorgan dysfunction that can manifest as capillary leak syndrome, coagulopathy, respiratory failure, myocardial dysfunction, renal insufficiency, and neurocognitive decline. In this review, pathophysiological aspects of CPB are considered from a practical point of view, and preventive strategies for hemodilutional anemia, coagulopathy, inflammation, metabolic derangement, and neurocognitive and renal dysfunction are discussed.
authors.affiliation: UPMC, Pittsburgh, PA, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Esper
authors.affiliation: UPMC, Pittsburgh, PA, USA.
authors.forename: Kathirvel
authors.initials: K
authors.lastname: Subramaniam
authors.affiliation: UPMC, Pittsburgh, PA, USA tanakak@upmc.edu.
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
mesh_terms: D000740:Anemia / Q000517:prevention & control* / Q000628:therapy; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000517:prevention & control* / Q000628:therapy; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D006438:Hemodilution; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D009102:Multiple Organ Failure / Q000517:prevention & control* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: anemia; bivalirudin; cardiopulmonary bypass; coagulopathy; heparin; hyperglycemia; inflammation; neurological complications; renal dysfunction; reperfusion injury