Brain Magnetic Resonance Imaging Abnormalities following Off-Pump Cardiac Surgery

Friday, Gary; Sutter, Francis P.; Curtin, Andrew; Kenton, Edgar J.; Caplan, Bruce; Nocera, Ronny; Siddiqui, Adnan H.; Goldman, Scott

doi:10.1532/hsf98.20041146

Cited by 29 publications

(16 citation statements)

References 12 publications

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“…27 Contrary to our findings, Friday et al 28 reported that new DW-MRI lesions were present in five (31%) of 16 patients after OPCAB surgery. Unfortunately, the authors did not report on the extent and severity of aortic atheroma.…”

Section: Discussioncontrasting

confidence: 99%

Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta

Djaiani

Fedorko

Cusimano

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:The purpose of this study was to determine if there is an association between the proximal thoracic aortic (ascending aorta and aortic arch) atheroma and ischemic brain lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) after on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass surgery. Methods:Patients who underwent ONCAB surgery (n = 13) and who had aortic atheroma > 2 mm were compared to a risk-adjusted prospective cohort of patients (n = 13) undergoing OPCAB surgery. Transesophageal echocardiography and epiaortic scanning were performed to assess the proximal thoracic aorta. Patients were evaluated for new ischemic brain lesions utilizing DW-MRI three to seven days after surgery. The NEECHAM confusion scale was used to evaluate patient consciousness. Results:The groups were comparable with respect to demographic data, and prevalence of preoperative risk factors. The extent and severity of aortic atheroma was similar in the two groups. The average maximum height of atheroma was 5.0 ± 2.0 mm in the OPCAB and 4.8 ± 1.9 in the ONCAB groups, respectively. The prevalence of new ischemic brain lesions on DW-MRI was 0% in the OPCAB group and 61% in the ONCAB group (P = 0.001). Patients in the OPCAB group were less confused during the first two postoperative days. Conclusion:Patients with aortic atheroma > 2 mm may have a lower risk of new ischemic brain lesions as identified by DW-MRI after OPCAB surgery. Patient stratification based upon aortic atheroma burden should be addressed in future trials designed to tailor treatment strategies to improve short-and long-term neurological outcomes in patients undergoing cardiac surgery. Objectif : Déterminer s'il y a une association entre l'athérome de l'aorte thoracique proximale (aorte ascendante et crosse de l'aorte) et les lésions cérébrales ischémiques à l'examen d'imagerie par résonance magnétique pondérée par diffusion (IRM-PD) à la suite du pontage aortocoronarien avec circulation extracorporelle (PACCE) et un PAC à coeur battant (PACCB). Méthode : Des patients subissant un PACCE (n = 13) et ayant de l'athérome aortique > 2 mm ont été comparés à une cohorte prospective de patients à risque ajusté (n = 13) subissant un PACCB. L'échocardiographie transoesophagienne et le balayage épiaortique ont permis d'évaluer l'aorte thoracique proximale. La présence de nouvelles lésions cérébrales ischémiques a été vérifiée avec l'IRM-PD trois à sept jours après l'opération. La conscience des patients a été évaluée par l'échelle de confusion NEECHAM. Résultats

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Section: Discussioncontrasting

confidence: 99%

Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta

Djaiani

Fedorko

Cusimano

et al. 2006

Can J Anesth/J Can Anesth

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“…This finding suggests that factors other than the use of the cardiopulmonary bypass are associated with postoperative ischemic lesions. 71 With a stroke rate of only 2% to 5% in the CABG group, it takes a study involving a large number of patients to reliably establish the beneficial effects of an alternative procedure, and most studies in the literature have sample sizes too small to show statistical significance. Nevertheless, a large study by Bucerius (nϭ16 184) found a difference in the incidence of stroke between conventional CABG (3.9%) and off pump group (2.5%), 10 indicating that stroke risk was reduced but not eliminated with this alternative procedure.…”

Section: Stroke After Other Cardiac Interventionsmentioning

confidence: 99%

Stroke and Encephalopathy After Cardiac Surgery

McKhann

Grega

Borowicz

et al. 2006

Stroke

308

170

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Background and Purpose-As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery. Summary of Review-Patients with preexisting cerebrovascular disease are at increased risk for these untoward neurological outcomes, which are associated with longer lengths of hospital stay, higher costs, and greater mortality. The mechanisms underlying these neurological events may include microemboli and hypoperfusion during surgery, and postoperative atrial fibrillation. Predictive models, based on information available before surgery, allow identification of these "high risk" patients. Conclusion-Establishing the degree of functionally significant vascular disease of the brain before surgery should be an essential part of the preoperative evaluation, particularly when modifications in surgical technique or novel neuroprotective agents are being evaluated. (Stroke. 2006;37:562-571.)

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“…[20] In a recent study, new diffusionweighted MRI lesions were found in five of 16 patients (31%) undergoing off-pump CABG. [21] In our study, new lesions were assessed using the same imaging modality and we found no statistically significant difference between the two groups in terms of the frequency and number of these lesions.…”

Section: Discussionmentioning

confidence: 53%

The impact on neurological outcomes with the new-generation membrane oxygenators with integrated arterial filters

Erkin¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, koroner arter baypas greftleme yapılan hastalarda, kardiyopulmoner baypasta kullanılan iki farklı oksijenatör sistemi olan, membran oksijenatöre entegreli ve entegresiz arteriyel filtrenin nörokognitif etkileri karşılaştırıldı.Ça lış ma pla nı: Bu prospektif, randomize çalışmaya Ocak 2015 -Aralık 2015 tarihleri arasında elektif koroner arter baypas greftleme yapılan toplam 40 hasta (36 erkek, 4 kadın; ort. yaş 60.0±8.5; dağılım 43-75 yıl) alındı. Hastalar kapalı zarf tekniği kullanılarak blok randomizasyon ile iki gruba ayrıldı. Grup 1'de arteriyel filtre entegresiz membran oksijenatörleri ve grup 2'de arteriyel filtre entegreli membran oksijenatörleri kullanıldı. Tüm hastalarda ameliyat sırasında serebral oksijenizasyon yakın kızılötesi spektroskopi ile değerlendirildi. Cerrahi işlemden 2-4 gün önce ve sonra, beyin difüzyon ağırlıklı manyetik rezonans görüntüleme yapıldı. Bilişsel fonksiyonlar ameliyat sonrası birinci ayda Montreal Bilişsel Değerlendirme testi ile değerlendirildi.Bul gu lar: Difüzyon ağırlıklı manyetik rezonans görüntülemede entegresiz grupta 11 hastada ve entegreli grupta yedi hastada yeni lezyonlar saptandı. Ameliyat öncesi ve sonrası toplam Montreal Bilişsel Değerlendirme skoru entegresiz ve entegreli grupta sırasıyla ortalama 27.9±3.3'e kıyasla 28.1±3.4 ve 26.2±3.1'e kıyasla 26.8±3 idi. Gruplar arasında yeni lezyon sayısı, yakın kızılötesi spektroskopi bulguları ve Montreal Bilişsel Değerlendirme skorları açısından istatistiksel olarak anlamlı bir fark yoktu.So nuç:Arteriyel filtre entegreli membran oksijenatörlerin, koroner arter baypas greftleme yapılan hastalarda, nörokognitif sonuçlar açısından, arteriyel filtresi entegre olmayan membran oksijenatörlere kıyasla, anlamlı bir üstünlükleri var gibi görünmemektedir.Anah tar söz cük ler: Bilişsel fonksiyonlar; difüzyon ağırlıklı manyetik rezonans görüntüleme; membran oksijenatörler. ABSTRACTBackground: This study aims to compare the neurocognitive effects of two different oxygenator systems, i.e. membrane oxygenator with or without integrated arterial filters, used during cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.

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Brain Magnetic Resonance Imaging Abnormalities following Off-Pump Cardiac Surgery

Cited by 29 publications

References 12 publications

Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta

Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta

Stroke and Encephalopathy After Cardiac Surgery

The impact on neurological outcomes with the new-generation membrane oxygenators with integrated arterial filters

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