Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study

Moody, Dixon M.; Brown, William R.; Challa, Venkata R.; Stump, David A.; Reboussin, David M.; Legault, Claudine

doi:10.1016/0003-4975(95)00057-r

Cited by 179 publications

(100 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Diffusion-weighted magnetic resonance imaging techniques indicate that about 50% of patients undergoing on-pump coronary artery bypass grafting develop discrete lesions suggestive of microembolic infarcts [6]. Postmortem studies have confirmed the association between similar lesions and embolic infarcts [49]. It has also been shown using transcranial doppler ultrasonography that on-pump surgery is associated with larger numbers of microemboli than off-pump surgery (cohort study, level-3 evidence [50]).…”

Section: Cerebral Microembolimentioning

confidence: 80%

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

Harten¹,

2012

View full text Add to dashboard Cite

SummaryPostoperative cognitive dysfunction is receiving increasing attention, particularly as it mainly affects the (growing) elderly population. Until recently, cognitive deficits after cardiac surgery were thought to be caused by physiological disturbances associated with the cardiopulmonary bypass technique. Although the technique of 'off-pump' coronary revascularisation may potentially be associated with improved outcome, long-term follow-up studies have failed to demonstrate a significant reduction in the incidence of postoperative cognitive dysfunction. The focus of research is thus shifting from cardiopulmonary bypass to other factors common to both techniques, such as surgery, anaesthesia and patient-related predisposing factors. Priming of the immune system by ageing and atherosclerosis may result in an exaggerated systemic and cerebral inflammatory response to cardiac surgery and anaesthesia, causing neuronal loss or dysfunction resulting in cognitive dysfunction. We briefly discuss the evidence for cardiopulmonary bypass-related neuronal injuries in adult cardiac surgery patients, and review the evidence that immune priming is a key factor in the pathogenesis of cognitive dysfunction after cardiac surgery.

show abstract

Section: Cerebral Microembolimentioning

confidence: 80%

A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia

Harten¹,

2012

View full text Add to dashboard Cite

show abstract

“…73 Experimental studies have suggested that the source of SCADs to be fat arising from the cardiotomy suction aspirate that is returned to the CPB reservoir. 14 In a small study, dogs undergoing hypothermic CPB using cardiotomy suction were found to have more SCADs/ cm 2 tissue (n=5, 46.5±14.5, p=0.04) than dogs undergoing CPB without cardiotomy suction (n=3, 4.54±1.69), right heart only CPB (n=3, 1.77±0.77), or lower extremity CPB (n=2, 4.17 ±1.65 SCADs/cm 2 tissue).…”

Section: Lipid Embolism From Pericardial Suction Aspiratementioning

confidence: 99%

Mechanisms of Cerebral Injury from Cardiac Surgery

Hogue

Gottesman

Stearns

2008

Critical Care Clinics

View full text Add to dashboard Cite

Cerebral injury is a frequent complication of cardiac surgery and has been associated with high mortality, morbidity, hospital costs, and an increased likelihood of admission to a secondary care facility after hospital discharge, and impaired quality of life. 47,71,78,86 There are a variety of manifestations of perioperative cerebral injury including ischemic (or, less commonly, hemorrhagic) stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients, and neurocognitive dysfunction affecting 20% to 30% of patients one month after surgery. 47,71,78,86 The range in reported incidences between studies is likely due to different patient populations (e.g., patient age and risk status, types of procedures), diagnostic definitions, and the intensity of clinical surveillance. Contemporary studies using sensitive brain MRI with diffusion weighted imaging report that as many as 45% of patients who have undergone cardiac surgery have new ischemic brain lesions that are often clinically undetected. 47,63The prevailing hypothesis, though not definitively proven, is that all forms of injury associated with cardiac surgery (i.e., stroke, encephalopathy, and neurocognitive dysfunction) have a similar etiology and that the manifestations depend on the extent and location of brain injury (e.g., motor cortex vs. areas subserving cognition). Many earlier studies that have described long-term neurocognitive changes after cardiac surgery have failed to include a non-surgical control group. 47,79 In a longitudinal study of patients with coronary artery disease undergoing either percutaneous coronary interventions or coronary artery bypass grafting (CABG), there were no differences in cognitive measures 36 months after either procedure. 88 These data imply that the effects of cardiac surgery on cognition may be short-lived (i.e., ~ 3 mo) and that progression of inherent cerebral vascular disease is a more important determinant of long-term cognitive decrements. These results further underscore the low sensitivity and specificity of psychometric testing for detecting cerebral injury in elderly populations with a high prevalence of preexisting cognitive impairment. 47In this paper, we will examine postulated mechanisms for cerebral injury from cardiac surgery. Most emphasis has been placed in the past on the intraoperative interval as being the period of highest cerebral vulnerability. Many clinical cerebral events, however, occur in the postoperative period. We have reported, in fact, that > 20% of clinical strokes occur after recovery from surgery and anesthesia. 45,71 Thus, patients must be considered vulnerable to cerebral injury any time during the perioperative period.

show abstract

“…The practice of retransfusing shed blood during cardiac surgery with cardiopulmonary bypass (CPB) using cardiotomy suction has been shown to be a major source of lipid micro-emboli (LME) (1)(2)(3)(4). These lipid emboli have been shown to form small thrombi in the vasculature, and histological examination of brain after cardiac surgery has demonstrated lipid deposits in the capillaries in this organ (4).…”

Section: Introductionmentioning

confidence: 99%

“…These lipid emboli have been shown to form small thrombi in the vasculature, and histological examination of brain after cardiac surgery has demonstrated lipid deposits in the capillaries in this organ (4). These phenomenon found in the capillary bed is sometimes referred to as small capillary arteriolar dilatations (SCADS) (4). In addition, SCADS/LME have been proposed as an important contributor to the postoperative cognitive dysfunction observed in some patients after surgery involving CPB (5;6).…”

Section: Introductionmentioning

confidence: 99%