OBJECTIVE: Cardiopulmonary bypass (CPB) is a lifesaving practice in cardiac surgery, but its use frequently is associated with cerebral injury and neurocognitive dysfunctions. Despite the involvement of numerous factors, microembolism occurring during CPB seems to be one of the main mechanisms leading to such alterations. The aim of the present study was to characterize the occurrence of cerebral microembolism with reference to microembolic amount, nature, and distribution in different combinations of cardiac procedures and CPB on the microembolic load. DESIGN: A retrospective observational clinical study. SETTING: A single-center regional hospital. PARTICIPANTS: Fifty-five patients undergoing elective cardiac surgery with CPB. INTERVENTIONS: Bilateral detection of the patients' middle cerebral arteries using a multifrequency transcranial Doppler. MEASUREMENTS AND MAIN RESULTS: Patients were divided into 3 groups depending on the CPB circuit used (open, open with vacuum, or closed). There was a significant difference between the number of solid and gaseous microemboli (p<0.001), with the solid lower than the gaseous ones. The number of solid microemboli was affected by group (p< 0.05), CPB phase (p<0.001), and laterality (p<0.01). The number of gaseous microemboli was affected only by group (p<0.05) and CPB phase (p<0.001). Generally, the length of CPB phase did not affect the number of microemboli. CONCLUSIONS: Surgical procedures combined with CPB circuits, but not the CPB phase length, affected the occurrence, nature, and laterality of microemboli.
OBJECTIVE: Cardiopulmonary bypass (CPB) is a lifesaving practice in cardiac surgery, but its use frequently is associated with cerebral injury and neurocognitive dysfunctions. Despite the involvement of numerous factors, microembolism occurring during CPB seems to be one of the main mechanisms leading to such alterations. The aim of the present study was to characterize the occurrence of cerebral microembolism with reference to microembolic amount, nature, and distribution in different combinations of cardiac procedures and CPB on the microembolic load. DESIGN: A retrospective observational clinical study. SETTING: A single-center regional hospital. PARTICIPANTS: Fifty-five patients undergoing elective cardiac surgery with CPB. INTERVENTIONS: Bilateral detection of the patients' middle cerebral arteries using a multifrequency transcranial Doppler. MEASUREMENTS AND MAIN RESULTS:Patients were divided into 3 groups depending on the CPB circuit used (open, open with vacuum, or closed). There was a significant difference between the number of solid and gaseous microemboli (p<0.001), with the solid lower than the gaseous ones. The number of solid microemboli was affected by group (p< 0.05), CPB phase (p<0.001), and laterality (p<0.01). The number of gaseous microemboli was affected only by group (p<0.05) and CPB phase (p<0.001). Generally, the length of CPB phase did not affect the number of microemboli. CONCLUSIONS: Surgical procedures combined with CPB circuits, but not the CPB phase length, affected the occurrence, nature, and laterality of microemboli.
Authors: Kyriakos Anastasiadis; John Murkin; Polychronis Antonitsis; Adrian Bauer; Marco Ranucci; Erich Gygax; Jan Schaarschmidt; Yves Fromes; Alois Philipp; Balthasar Eberle; Prakash Punjabi; Helena Argiriadou; Alexander Kadner; Hansjoerg Jenni; Guenter Albrecht; Wim van Boven; Andreas Liebold; Fillip de Somer; Harald Hausmann; Apostolos Deliopoulos; Aschraf El-Essawi; Valerio Mazzei; Fausto Biancari; Adam Fernandez; Patrick Weerwind; Thomas Puehler; Cyril Serrick; Frans Waanders; Serdar Gunaydin; Sunil Ohri; Jan Gummert; Gianni Angelini; Volkmar Falk; Thierry Carrel Journal: Interact Cardiovasc Thorac Surg Date: 2016-01-26
Authors: Jeffrey N Browndyke; Miles Berger; Patrick J Smith; Todd B Harshbarger; Zachary A Monge; Viral Panchal; Tiffany L Bisanar; Donald D Glower; John H Alexander; Roberto Cabeza; Kathleen Welsh-Bohmer; Mark F Newman; Joseph P Mathew Journal: Hum Brain Mapp Date: 2017-11-21 Impact factor: 5.038