Cerebral emboli and cognitive outcome after cardiac surgery

Stump, David A.; Rogers, Anne T.; Hammon, John W.; Newman, Stanton

doi:10.1016/s1053-0770(96)80186-8

Cited by 224 publications

(136 citation statements)

References 30 publications

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“…In addition, emboli can be caused by disruption of aortic atherosclerotic plaques by aortic manipulation and cannulation. It has been hypothesised that although occlusion of larger cerebral vessels causes focal neurological damage, more diffusely spread very small cerebral emboli could cause the more subtle deficits associated with POCD [48]. 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].…”

Section: Cerebral Microembolimentioning

confidence: 99%

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

Harten¹,

2012

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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.

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Section: Cerebral Microembolimentioning

confidence: 99%

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

Harten¹,

2012

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“…The latter possibility appears to be more probable considering the neurological complications arising shortly after a cardiac surgery. Case reports and reviews about the neural effects of such a serious surgical intervention reported that the brain can suffer hypoperfusion during the surgical procedure after which recovering patients often have postoperative cognitive disorders [24,25,51]. A plausible explanation of the phenomenon is that the decreased, intraoperative cerebral perfusion can create an imbalance between oxygen demand and supply in the brain, which is probably responsible for the postoperative memory deficit after cardiac surgery [5].…”

Section: Hypertension Dementia and Cbfmentioning

confidence: 99%

Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related?☆

Farkas

Vos

Steur

et al. 2000

Neurobiology of Aging

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“…Recent studies estimate that 33À80% of patients undergoing open-heart surgery have some degree of post-operative neurological impairment [1,2]. Although grossly evident neurological dysfunction has decreased with improvements in surgical protocols, cognitive dysfunction still occurs in a large number of patients [3]. One possible cause of such neurological dysfunction may be the impaired perfusion of blood in the microvasculature resulting from emboli that may have formed in the blood.…”

Section: Introductionmentioning

confidence: 99%

Hypothermia‐induced platelet aggregation in heparinized flowing human blood: Identification of a high responder subpopulation

Hall¹,

Goodman²,

Alston³

et al. 2001

American J Hematol

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Cold-induced platelet aggregation (CIPA) in PRP has previously been documented in connection with platelet preservation (4±15°C). This report describes hypothermia-induced platelet aggregation (HIPA) in whole blood and at temperatures used in open-heart surgery (24±32°C). HIPA (speci®cally, the formation of occlusive aggregates) was studied in human whole blood. Fresh heparinized (1.5 U/ml) human blood was cooled and maintained at target temperatures (15, 20, 24, 28, 32, or 37°C) as it¯owed (1 ml/min) through 75-cm long 1/32" internal diameter polymer conduit. The formation of aggregates in the tubing was veri®ed using optical video microscopy and was quanti®ed by a lightscattering method and a constant-pressure ®ltration method. Donors were tested at least twice at each target temperature and were classi®ed into three separate response regimes (Low, Medium, and High) on the basis of the number of aggregates and the duration of their appearance. The screening of 121 donors (average age 22.3 4.3 years) for HIPA at 24°C (the temperature of maximum response) indicated 14% High Responders, 18% Medium Responders, and 68% Low Responders. HIPA was inhibited by EDTA, citrate, PGE 1 , and Tiro®ban, but not by aspirin, and it was enhanced by elevated heparin levels. HIPA was consistently noted in the blood of a subpopulation of donors, and the associated platelet aggregates in the blood of High Responders were rigid and occlusive. It is postulated that such aggregates may contribute to cognitive dysfunction noted in patients undergoing hypothermic open-heart surgery, and that postulus is being investigated. Am.

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Cerebral emboli and cognitive outcome after cardiac surgery

Cited by 224 publications

References 30 publications

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

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

Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related?☆

Hypothermia‐induced platelet aggregation in heparinized flowing human blood: Identification of a high responder subpopulation

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