The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

Abstract

Despite many advances since Gibbon’s first cardiopulmonary bypass (CPB) in 1953, end-organ damage and neurologic dysfunction remain a challenge in the management of pediatric patients undergoing cardiac surgery. A comprehensive understanding of the inflammatory process caused by CPB has led to intraoperative strategies that intend to minimize such responses. Exposure of blood to the CPB circuit induces a complex systemic inflammatory response (SIRS), which involves the activation of multiple, interdependent cellular and humoral pathways. The coagulation and complement pathways are activated when the plasmatic proteins are exposed to the circuit material. Once cellular activation occurs, released proinflammatory cytokines, adhesion molecules, and chemokines are responsible for the amplification of the inflammatory cascade. Each of the inflammatory cascade components has an important role in a process that ultimately results in vascular injury and end-organ damage.