Effect on the Brain of Two Techniques of Myocardial Protection

Abstract

This study compared the occurrence of intraoperative microemboli and postoperative changes in neuropsychological performance in 195 patients undergoing coronary artery bypass grafting who were randomized to intermittent crossclamp fibrillation or cardioplegic arrest. Cerebral microemboli were recorded from cannulation to 15 min after decannulation, using transcranial Doppler in 166 patients. Microemboli in relation to 9 surgical events were also noted. Neuropsychological change scores were obtained by comparing cognitive performance preoperatively with that at 6-8 weeks after surgery. The median number of microemboli detected was 105 (range, 9-1,757) in the fibrillation group, and 110 (range, 1-1,306) in the cardioplegia group, with no significant difference between groups. There was also no significant difference between groups in the generation of microemboli during any of the surgical events. Neuropsychological tests were completed postoperatively by 177 participants, with no significant differences in performance found between the 2 groups. Given the equivalence of the effect of intermittent crossclamp fibrillation and cardioplegic arrest on microemboli and neuropsychology, consideration of which form of myocardial protection to employ should perhaps focus more on which method affords most protection to the heart.

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

“…Post hoc findings suggest an association between emboli and acute (3-week) Stroop change score, but did not contribute to the predictive model. Although there are more reports that emboli frequency do not relate to cognitive change (69-71) than otherwise (72), study sample neurovascular burden factors and the interaction with emboli remain poorly understood. Small emboli may lodge in regions with low blood flow (73), and regions of the brain with leukoaraiosis might represent such regions.…”

Fibrillation without Cross-Clamping in the Pesence of Sclerotic Ascending Aorta

“…1 We believe the manuscript requires certain points to be stressed on. Additionally, we would like to comment on the issue about the use of fibrillation technique with our modification.…”

“…We read with great interest the manuscript by Stygall J et al comparing intermittent crossclamp fibrillation and cardioplegic arrest during coronary artery bypass grafting on microemboli and neuropsychology. 1 We believe the manuscript requires certain points to be stressed on. Additionally, we would like to comment on the issue about the use of fibrillation technique with our modification.…”