title: Blood-Brain Barrier Disruption After Cardiopulmonary Bypass: Diagnosis and Correlation to Cognition.
abstract: BACKGROUND
  Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response that may impair blood-brain barrier (BBB) integrity. BBB disruption can currently be detected by dynamic contrast enhancement magnetic resonance imaging (MRI), reflected by an increase in the permeability constant (Ktrans). We aimed to determine (1) whether CPB induces BBB disruption, (2) duration until BBB disruption resolution, and (3) the obtainable correlation between BBB injury (location and intensity) and neurocognitive dysfunction.
  
  
  METHODS
  Seven patients undergoing CPB with coronary artery bypass grafting (CABG) were assigned to serial cerebral designated MRI evaluations, preoperatively and on postoperative day (POD) 1 and 5. Examinations were analyzed for BBB disruption and microemboli using dynamic contrast enhancement MRI and diffusion-weighted imaging methods, respectively. Neuropsychologic tests were performed 1 day preoperatively and on POD 5.
  
  
  RESULTS
  A significant local Ktransincrease (0.03 min-1vs 0.07 min-1, p = 0.033) compatible with BBB disruption was evident in 5 patients (71%) on POD 1. Resolution was observed by POD 5 (mean, 0.012 min-1). The location of the disruption was most prominent in the frontal lobes (400% vs 150% Ktranslevels upsurge, p = 0.05). MRI evidence of microembolization was demonstrated in only 1 patient (14%). The postoperative global cognitive score was reduced in all patients (98.2 ± 12 vs 95.1 ± 11, p = 0.032), predominantly in executive and attention (frontal lobe-related) functions (91.8 ± 13 vs 86.9 ± 12, p = 0.042). The intensity of the dynamic contrast enhancement MRI BBB impairment correlated with the magnitude of cognition reduction (r = 0.69, p = 0.04).
  
  
  CONCLUSIONS
  BBB disruption was evident in most patients, primarily in the frontal lobes. The location and intensity of the BBB disruption, rather than the microembolic load, correlated with postoperative neurocognitive dysfunction.
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel. Electronic address: danab3@clalit.org.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Abrahamov
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Levran
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Naparstek
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Refaeli
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Shani
authors.initials: S
authors.lastname: Kaptson
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Mahmud
authors.initials: M
authors.lastname: Abu Salah
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Ishai
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Sahar
mesh_terms: D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013997:Time Factors