| Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures. | |
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MedLine Citation:
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PMID: 15173734 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Neurocognitive dysfunction remains a limitation of cardiac surgery with cardiopulmonary bypass. Intraoperative cerebral microembolization is believed to be one of the most important etiologic factors. Using a new generation of transcranial Doppler ultrasonography, we compared the number and nature of intraoperative microemboli in patients undergoing on-pump and off-pump cardiac surgery procedures. METHODS: Bilateral continuous transcranial Doppler monitoring of the middle cerebral arteries was performed in 45 patients (15 off-pump coronary artery bypass grafting, 15 on-pump coronary artery bypass grafting, and 15 open cardiac procedures). All recordings were performed using a multi-range, multifrequency system to allow both measurement of the number and discrimination of the nature of microemboli in the 3 different groups. RESULTS: The median number (interquartile range) of microemboli in the off-pump coronary artery bypass grafting, on-pump coronary artery bypass grafting, and open procedure groups were 40 (28-80), 275 (199-472), and 860 (393-1321), respectively (P <.01). Twelve percent of microemboli in the off-pump coronary artery bypass grafting group were solid compared with 28% and 22% in the on-pump coronary artery bypass grafting and open procedure groups, respectively (P <.05). In the on-pump groups, 24% of microemboli occurred during cardiopulmonary bypass, and 56% occurred during aortic manipulation (cannulation, decannulation, application, and removal of crossclamp or sideclamp). CONCLUSIONS: Cerebral microembolization is significantly reduced with avoidance of cardiopulmonary bypass. The majority of microemboli occurring during cardiac surgery are gaseous, with a higher proportion of solid microemboli in the on-pump group, and may have a different significance for cerebral injury than solid microemboli. The ability to reliably discriminate gas and solid microemboli may have an important role in the implementation of neuroprotective strategies. |
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Authors:
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Yasir Abu-Omar; Lognathen Balacumaraswami; David W Pigott; Paul M Matthews; David P Taggart |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 127 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2004 Jun |
Date Detail:
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Created Date: 2004-06-02 Completed Date: 2004-07-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1759-65 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiopulmonary Bypass / adverse effects, methods Coronary Artery Bypass / adverse effects*, methods* Coronary Disease / surgery, ultrasonography Embolism, Air / epidemiology, ultrasonography* Female Follow-Up Studies Humans Incidence Intracranial Embolism and Thrombosis / epidemiology, ultrasonography* Intraoperative Complications / epidemiology, ultrasonography* Male Middle Aged Monitoring, Intraoperative / methods Probability Prospective Studies Risk Assessment Treatment Outcome Ultrasonography, Doppler, Transcranial |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2005 May;129(5):1194; author reply 1194-5
[PMID:
15867810
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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