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Central Nervous System Complications in Cardiac Surgery: Retrograde Cerebral Perfusion, Pressure, Pulsatility, Temperature, and pH Management During Cardiopulmonary Bypass

Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

Currently, clinical management strategies during cardio pulmonary bypass (CPB) are undergoing profound changes. Renewed interest in normothermic versus hypothermic perfusion during CPB has resulted in appar ently contradictory results regarding patient outcomes. Much effort has been devoted to defining physiological responses of the brain to various alterations during CPB (eg, pH strategy, normothermia versus hypothermia, pulsatile or nonpulsatile perfusion, use of arterial line filtration, circulatory arrest, retrograde cerebral perfu sion). In addition, prospective studies are examining the impact of diverse strategies on neuropsychological and neurological outcomes after CPB, to define optimal management techniques.

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