Document Detail


Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures.
MedLine Citation:
PMID:  15173734     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Yasir Abu-Omar; Lognathen Balacumaraswami; David W Pigott; Paul M Matthews; David P Taggart
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2004-06-02     Completed Date:  2004-07-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1759-65     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
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:
J Thorac Cardiovasc Surg. 2005 May;129(5):1194; author reply 1194-5   [PMID:  15867810 ]

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


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