ABSTRACT
The role of endothelial and leukocyte adhesion molecules in the vascular damage and subsequent organ dysfunction related to cardiopulmonary bypass is an emerging area of interest that is based on the intense and continuing basic discoveries in the area of cellular adhesion research. Leukocyte and endothelial adhesion and subsequent activation underlie both the vascular injury resulting from extracorporeal circulation per se as well as that resulting from the ischemia and reperfusion that occur during bypass and circulatory arrest. Such injury may well underlie a substantial proportion of the brain injury resulting from pediatric cardiac surgery. Subsequent adherence to specific endothelial ligands plays a role in localization of leukocytes in specific vascular beds in poorly understood ways and also appears to result in secretory functions by the leukocyte. Deliberate, hypothermic ischemia with subsequent reperfusion is used routinely during clinical cardiopulmonary bypass in specific organ beds and, as total circulatory arrest, in the entire body including the brain.
