Document Detail

Retinal and cerebral microembolization during coronary artery bypass surgery: a randomized, controlled trial.
MedLine Citation:
PMID:  16365207     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We sought to compare the effects on ophthalmic function of coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and off-pump (OPCAB) grafting and to investigate whether retinal microvascular damage is associated with markers of cerebral injury. METHODS AND RESULTS: Retinal microvascular damage was assessed by fluorescein angiography and color fundus photography. Ophthalmic function was tested by the logarithm of the minimum angle of resolution visual acuity (VA), and cerebral injury, by transcranial Doppler ultrasound-detected emboli and S100 protein values. Twenty patients were randomized. Fluorescein angiography and postoperative VA could not be obtained for 1 CABG-CPB patient. Retinal microvascular damage was detected in 5 of 9 CABG-CPB but in none of 10 OPCAB patients (risk difference, 55%; 95% confidence interval [CI], 23% to 88%; P=0.01). Color fundus photography detected microvascular damage in 1 CABG-CPB patient but in no OPCAB patients; this lesion was associated with a field defect, which remained after 3 months of follow-up. There was no difference in postoperative VA. Doppler high-intensity transient signals (HITS) were 20.3 times more frequent in the CABG-CPB than in the OPCAB group (95% CI, 9.1 to 45; P<0.0001). Protein S100 levels were higher in the CABG-CPB than in the OPCAB group 1 hour after surgery (P<0.001). HITS were 14.7 times more frequent (95% CI, 3.5 to 62; P=0.001) and S100 level 2.1 times higher (95% CI, 1.3 to 3.5; P=0.005) when retinal microvascular damage was present. CONCLUSIONS: The relative frequency of retinal microvascular damage between groups shows the extent to which the risk of cerebral injury is reduced with OPCAB. Imaging of part of the cerebral circulation provides evidence to validate markers of cerebral injury.
Raimondo Ascione; Arup Ghosh; Barnaby C Reeves; John Arnold; Mike Potts; Atul Shah; Gianni D Angelini
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-20     Completed Date:  2006-02-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3833-8     Citation Subset:  AIM; IM    
Bristol Heart Institute, University of Bristol, Bristol, England.
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MeSH Terms
Cardiopulmonary Bypass / adverse effects
Coronary Artery Bypass / adverse effects*,  methods*
Coronary Artery Bypass, Off-Pump / adverse effects
Embolism / etiology*
Fluorescein Angiography
Intracranial Embolism / etiology*
Microcirculation / pathology*
Middle Aged
Retinal Vessels / pathology*
S100 Proteins / blood
Ultrasonography, Doppler
Visual Acuity
Reg. No./Substance:
0/S100 Proteins
Comment In:
Circulation. 2005 Dec 20;112(25):3816-7   [PMID:  16365204 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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