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J Thorac Cardiovasc Surg 2004;127:1781-1788
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Higher bypass temperature correlates with increased white cell activation in the cerebral microcirculation

^a Department of Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA
^b Department of Biostatistics, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA
^c Department of Pathology, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA
^d Department of Surgery, University Hospital of Oulu, Oulu, Finland

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication June 13, 2003; revisions received October 10, 2003; accepted for publication January 8, 2004.

^* Address for reprints: Richard A. Jonas, MD, Department of Cardiac Surgery, Children's Hospital Boston, 300 Longwood Ave, Boston MA 02115, USA
richard.jonas{at}TCH.harvard.edu

OBJECTIVE: Cardiopulmonary bypass induces a systemic inflammatory response, which in turn promotes a cascade of leukocyte and endothelial cell activity. We investigated whether differences in bypass temperature and flow rate affect endothelial cell and leukocyte adhesion in the cerebral microcirculation.

METHODS: Thirty-six piglets (13.0 ± 1.1 kg) had a cranial window placed over the parietal cortex to evaluate the microcirculation by means of intravital microscopy. Animals were cooled to a temperature of 15°C, 25°C, or 34°C on cardiopulmonary bypass with hematocrit levels of 20% or 30% by using pH-stat management, followed by 60 minutes of reduced flow (10, 25, or 50 mL · kg^–1 · min^–1). Rhodamine staining was used to observe adherent and rolling leukocytes in postcapillary venules.

RESULTS: Higher bypass temperature correlated with significantly more adherent and rolling leukocytes during the full 60 minutes of low-flow bypass (P < .05). Poisson regression revealed more adherent leukocytes at 34°C than at 15°C and at a flow rate of 10 mL · kg^–1 · min^–1 compared with a flow rate of 50 mL · kg^–1 · min^–1. There was an inverse correlation between flow rate and the number of adherent and rolling leukocytes at 30, 45, and 60 minutes of low-flow bypass (P < .05). Temperature was a multivariable predictor of histologic score, with greater neurologic damage found after bypass at 34°C (P < .01).

CONCLUSIONS: Leukocyte activation in cerebral microcirculation is increased with higher temperature and lower flow rate, suggesting that these variables influence the inflammatory response during cardiopulmonary bypass.

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