| Cerebral cortical oxygenation changes during OPCAB surgery. | |
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MedLine Citation:
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PMID: 14602278 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We investigated the changes occurring in cerebral cortical oxygenation during off-pump coronary artery bypass (OPCAB) surgery using near infrared spectroscopy (NIRS). METHODS: Measurement of cerebral cortical oxygenation changes included concentration of deoxygenated hemoglobin [HHb], oxygenated hemoglobin [O(2)Hb], changes in the redox status of the cytochrome c oxidase [Cyt-Ox], cerebral saturation as expressed by the tissue oxygenation index (TOI), and cerebral blood volume (CBV) as expressed by tissue hemoglobin index (THI). Measurements were performed in 23 consecutive patients during grafting of: left anterior descending (LAD setup 1; n = 23), posterior descending (PDA setup 2; n = 17), and Circumflex (Cx setup 3; n = 19) coronary arteries. Measurements were performed before any surgical manipulation (baseline), following positioning of the pressure stabilizer during construction of the distal anastomosis and 2 minutes after the completion of each distal anastomosis with the heart returned to its natural position. RESULTS: There were no in-hospital deaths, neurologic deficits, or myocardial infarcts. Compared to baseline, during LAD grafting there was a marked reduction in [O(2)Hb] [-1.08 (-1.77 to -0.39), mean difference (95% CI) (p < 0.0008)], without a significant change in [HHb]. There was also a 4% reduction in cerebral saturation and a 3% fall in CBV (both p < 0.05). Setup 2 (PDA) was associated with a marked decrease of [O(2)Hb] [-1.92 (-2.95 to -0.88) mean difference (95% CI) (p < 0.0025)], which was accompanied by an increase in [HHb] [1.89 (1.00 to 2.77) mean difference (95% CI) (p < 0.0025)], and a 4% reduction in cerebral saturation (p < 0.0008). Grafting of the Cx was associated with a marked increase in [HHb] [2.85 (1.46 to 4.2) mean difference (95% CI) (p < 0.0025)], with no changes in [O(2)Hb], a 6% reduction in cerebral saturation, and a 12% increase in CBV (both p < 0.05). In all 3 settings, however, the changes were not associated with a modification in the redox state of [Cyt-Ox]. On returning to baseline condition, the changes in [O(2)Hb] and TOI observed in setup 1 persisted, and a significant reduction was observed in the redox state of the [Cyt-Ox] when compared with baseline [-0.08 (-0.14 to -0.02) mean difference (95% CI) (p < 0.002)]. For setups 2 and 3 there was recovery of the cerebral cortical oxygenation. CONCLUSIONS: Grafting of the LAD on the beating heart is responsible for changes in cerebral cortical oxygenation which persist early after returning the heart to its natural position. Grafting of the Cx and PDA result in transient reversible changes. Trendelenburg positioning and right lateral tilting of the operating table during grafting of lateral and posterior walls might have a protective role in preventing cerebral cortical ischemia. Further studies are needed to assess the clinical importance of these observations. |
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Authors:
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Sudath P Talpahewa; Raimondo Ascione; Gianni D Angelini; A Timothy Lovell |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 76 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-06 Completed Date: 2003-12-10 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1516-22; discussion 1522 Citation Subset: AIM; IM |
Affiliation:
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Bristol Heart Institute, University of Bristol, Bristol, United Kingdom. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brain Ischemia / prevention & control* Cardiopulmonary Bypass Cerebrovascular Circulation / physiology Cohort Studies Confidence Intervals Coronary Angiography Coronary Artery Bypass / adverse effects, methods* Coronary Stenosis / radiography, surgery* Female Follow-Up Studies Humans Intraoperative Complications / prevention & control* Male Middle Aged Monitoring, Intraoperative / methods Oxygen / therapeutic use* Oxygen Consumption / physiology Oxygenators Probability Prospective Studies Sensitivity and Specificity Severity of Illness Index Spectroscopy, Near-Infrared |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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