Cerebral Hypoxia During Cardiopulmonary Bypass: A Magnetic Resonance Imaging Study

Mutch, W. Alan C.; Ryner, Lawrence; Kozłowski, Piotr; Scarth, Gordon B.; Warrian, R. Keith; Lefevre, Gerald R.; Wong, Ted G; Thiessen, D. B.; Girling, Linda G.; Doiron, Leonard; McCudden, C.; Saunders, John K.

doi:10.1016/s0003-4975(97)00634-6

Cited by 42 publications

(17 citation statements)

References 24 publications

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“…Potential perioperative events that may negatively interact with preoperative leukoaraiosislacunae volume include acute anemia (60)(61)(62)(63), hypotension (64), oxygen desaturation (65)(66)(67), and the production of emboli. In our sample, we acquired valid emboli data on 15 of our surgery participants.…”

Section: Considerations For Neuropsychological Measures and Potentialmentioning

confidence: 99%

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

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Schmalfuss

et al. 2014

Survey of Anesthesiology

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Background-Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that: 1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and 2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.

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Section: Considerations For Neuropsychological Measures and Potentialmentioning

confidence: 99%

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

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Schmalfuss

et al. 2014

Survey of Anesthesiology

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“…Our a priori hypothesis was that patients undergoing CABG would be at greater risk of dementia than either patients managed with PCI or medical management – based on a number of studies examining cognitive dysfunction after open-heart surgery. Stated causes for increased risk of cognitive cerebral injury with open heart surgery – especially on-pump procedures – includes embolic deposition to the brain (air or particulate matter), blood pressure fluctuations, non-physiological pulsation during extracorporeal perfusion, activation of the inflammatory cascade due to blood elements contacting non-endothelialized surfaces and altered cerebral oxygenation, among others [27]–[29]. Embolic risk – although of lesser magnitude – is also present with PCI as retrograde cannulation through the aorta is required for this procedure.…”

Section: Discussionmentioning

confidence: 99%

Dementia and Depression with Ischemic Heart Disease: A Population-Based Longitudinal Study Comparing Interventional Approaches to Medical Management

et al. 2011

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BackgroundWe compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical).Methods and FindingsDe-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients.ConclusionsPatients managed with PCI had the lowest likelihood of dementia—only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation.

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“…This was possibly because when the PaO 2 was corrected for temperature, the highest PaO 2 obtained was 27.57 kPa [26]. In fact, the brain uses mainly dissolved oxygen during deep hypothermic CPB and there may well be an advantage in using high oxygen tensions, particularly at low flow [39], because there is evidence for regional brain hypoxia [130]. Further research is needed, but currently the available evidence supports the maintenance of as high an oxygen tension as possible.…”

Section: Arterial Oxygen Tensionmentioning

confidence: 99%

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

Kirkham¹

1998

Pediatr Cardiol

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Because of advances in surgical and cardiopulmonary bypass techniques it is now possible to definitively repair the vast majority of congenital heart disease in infancy or childhood. Although the majority of survivors do not have obvious cerebral sequelae, there is increasing disquiet about the high incidence of acute neurological events in the immediated postoperative period as well as evidence that at long-term follow-up there are subtle cognitive and motor deficits in many. Some children are more at risk of neurodevelopmental problems, either because of their cardiac (e.g. , extensive aortopulmonary collaterals) or cerebrovascular (e.g., the propensity to large vessel dissection) anatomy or because of genetic predisposition (e.g., to prothrombotic disorders). The incidence may vary with the surgery (e.g., the Fontan operation) and the cardiopulmonary bypass technique necessary to achieve an adequate technical repair (e.g., low or no flow at deep hypothermia). Recognition of the population at risk will lead to prevention of serious sequelae. Data collected in adults may be misleading, and many pediatric units have developed their own practice, but recent studies in animal models of child surgery and in children have produced some evidence to guide management to ensure the optimal cerebral as well as cardiac outcome. Pump flow should be maintained at least 30 ml/kg/min where possible, with inotropic support to maintain blood pressure if necessary. If pump flow must be lowered or circulatory arrest is essential, thorough cerebral cooling to deep hypothermic temperatures is mandatory; a pH-stat strategy may make this easier, but an alpha-stat strategy may be better in those operations that can be performed at moderate hypothermia. There is no evidence that the available pulsatile pumps offer an advantage. Tissue oxygenation may reach critical levels and a high hematocrit and oxygen tension may reduce the risk of significant hypoxia. There is a risk of embolization in children, which can be reduced with membrane oxygenators and careful monitoring; the role of arterial filtration remains controversial. The only protective agent that can currently be recommended is methylprednisolone to protect the spinal cord (e.g., in operations on the aortic arch). Further studies are needed in this important area.

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Cerebral Hypoxia During Cardiopulmonary Bypass: A Magnetic Resonance Imaging Study

Cited by 42 publications

References 24 publications

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Dementia and Depression with Ischemic Heart Disease: A Population-Based Longitudinal Study Comparing Interventional Approaches to Medical Management

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

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