BACKGROUND: This study aimed to determine whether there was any association between the intensity of intraoperative gaseous microembolic signals (GME), neuropsychological testing and clinical outcome in high-risk patients undergoing coronary artery surgery (CABG). METHODS: Over a 6-month period, GME activity was monitored in 102 Euroscore 6+ patients during cardiopulmonary bypass (CPB) with a conventional 32-micron arterial filter by non-invasive, real-time ultrasonic device. Cognitive tests; line bisection, the Stroop test, finger tapping, and the Rey Auditory Verbal Learning Test were performed at baseline, postoperative one week and postoperative one month. RESULTS: The distribution of GME activity showed that there were three groups of patients: >500 total emboli (n = 38); 250 to 500 emboli (n = 30) and <250 emboli (n = 34) at a detection level of 2% of the circuit diameter on the arterial side. Line bisection, the Stroop test and finger tapping were impaired significantly in >500 emboli patients versus control (<250 emboli) in postoperative week one, but resolved in one month. CONCLUSIONS: Correlation between intraoperative GME intensity and neurocognitive tests suggests that the level of GME might have a role in determining the psychological outcome after CABG with CPB.
BACKGROUND: This study aimed to determine whether there was any association between the intensity of intraoperative gaseous microembolic signals (GME), neuropsychological testing and clinical outcome in high-risk patients undergoing coronary artery surgery (CABG). METHODS: Over a 6-month period, GME activity was monitored in 102 Euroscore 6+ patients during cardiopulmonary bypass (CPB) with a conventional 32-micron arterial filter by non-invasive, real-time ultrasonic device. Cognitive tests; line bisection, the Stroop test, finger tapping, and the Rey Auditory Verbal Learning Test were performed at baseline, postoperative one week and postoperative one month. RESULTS: The distribution of GME activity showed that there were three groups of patients: >500 total emboli (n = 38); 250 to 500 emboli (n = 30) and <250 emboli (n = 34) at a detection level of 2% of the circuit diameter on the arterial side. Line bisection, the Stroop test and finger tapping were impaired significantly in >500 emboli patients versus control (<250 emboli) in postoperative week one, but resolved in one month. CONCLUSIONS: Correlation between intraoperative GME intensity and neurocognitive tests suggests that the level of GME might have a role in determining the psychological outcome after CABG with CPB.
Authors: Michael J Mack; Michael A Acker; Annetine C Gelijns; Jessica R Overbey; Michael K Parides; Jeffrey N Browndyke; Mark A Groh; Alan J Moskowitz; Neal O Jeffries; Gorav Ailawadi; Vinod H Thourani; Ellen G Moquete; Alexander Iribarne; Pierre Voisine; Louis P Perrault; Michael E Bowdish; Michel Bilello; Christos Davatzikos; Ralph F Mangusan; Rachelle A Winkle; Peter K Smith; Robert E Michler; Marissa A Miller; Karen L O'Sullivan; Wendy C Taddei-Peters; Eric A Rose; Richard D Weisel; Karen L Furie; Emilia Bagiella; Claudia Scala Moy; Patrick T O'Gara; Steven R Messé Journal: JAMA Date: 2017-08-08 Impact factor: 56.272