Evidence for Improved Cerebral Function After Minimally lnvasive Bypass Surgery

BhaskerRao, Bobby; VanHimbergen, Daniel J.; Edmonds, Harvey L.; Jaber, Saad F.; Ali, Ahsan T.; Pagni, Sebastian; Koenig, Steven C.; Spence, Paul A.

doi:10.1111/j.1540-8191.1998.tb01050.x

Cited by 81 publications

(41 citation statements)

References 12 publications

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“…Our results confirm recent studies that report a significant difference in MES observed in myocardial revascularization with and without CPB [12][13][14][15][16] . BhaskerRao and coworkers 12 compared neurologic outcome in 305 patients undergoing conventional CABG with CPB to 17 patients undergoing minimally invasive bypass surgery.…”

Section: Discussionsupporting

confidence: 83%

“…BhaskerRao and coworkers 12 compared neurologic outcome in 305 patients undergoing conventional CABG with CPB to 17 patients undergoing minimally invasive bypass surgery. They found a significantly higher number of MES in the CPB group and suggested that this finding is associated with the lower scores in the neuropsychologic examination observed in this group.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Malheiros

Massaro²,

Gabbai³

et al. 2001

Arq. Neuro-Psiquiatr.

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-Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.KEY WORDS: coronary artery bypass, transcranial Doppler, postoperative complications, cardiopulmonary bypass, treatment outcome.Existe relação entre o número de microêmbolos e a evolução neurológica nas cirurgias de revascularização miocárdica?RESUMO -A cirurgia de revascularização miocárdica sem circulação extracorpórea (CEC) pode estar relacionada com uma potencial redução no número dos microêmbolos (ME) associados com a manipulação da aorta ou gerados pelo equipamento, com consequente redução do risco de complicações neurológicas nestes pacientes. Nosso objetivo foi comparar a frequência de ME e de complicações neurológicas em pacientes operados sem e com CEC. Vinte pacientes selecionados para revascularização miocárdica eletiva sem CEC foram randomizados para cirurgia com e sem CEC. A monitorização contínua com Doppler transcraniano foi realizada durante todo o procedimento nos dois grupos e os pacientes foram examinados antes e após a cirurgia. Os grupos não apresentaram diferenças significativas em relação aos aspectos demográficos, fatores de risco, grau de ateromatose de aorta e número de pontes realizadas. A frequência de ME no grupo operado sem CEC foi significativamente menor do que no grupo operado com CEC, entretanto, nenhum paciente apresentou alterações no exame neurológico no período pós-operatório inicial. Esta observação pode sugerir que as complicações neurológicas possam estar mais relacionadas com o tamanho e a composição, do que com o número de ME. Somente um estudo prospectivo com maior número de pacientes poderá esclarecer este assunto.PALAVRAS-CHAVE: revascularização miocárdica, ponte de artéria coronária, complicações pós-operatórias, Doppler transcraniano, circulação extracorpórea.From the

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Malheiros

Massaro²,

Gabbai³

et al. 2001

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

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“…7,8 Pathological examination by Moody et al 9 of the brain after conventional CABG revealed the presence of multiple emboli lodged in small cerebral arterioles and capillaries. Additionally, BhaskerRao et al 7 documented in a prospective study that cerebral dysfunction was significantly lower after CABG without cardiopulmonary bypass compared with on-pump CABG. Previous investigators have also found an association between prolonged cardiopulmonary bypass time (Ͼ120 minutes) and increased risk of postoperative stroke.…”

Section: Discussionmentioning

confidence: 99%

Stroke After Coronary Artery Bypass

Stamou

Hill

Dangas

et al. 2001

Stroke

299

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Background and Purpose —Early postoperative stroke is a serious adverse event after coronary artery bypass grafting (CABG). This study sought to investigate risk factors, prevalence, and prognostic implications of postoperative stroke in patients undergoing CABG. Methods —We investigated the predictors of postoperative stroke (n=333, 2%) in 16 528 consecutive patients who underwent CABG between September 1989 and June 1999 in our institution. Predictors of postoperative stroke were identified by logistic regression analysis. Results —Among the preoperative and postoperative factors, significant correlates of stroke included (1) chronic renal insufficiency ( P <0.001), (2) recent myocardial infarction ( P =0.01), (3) previous cerebrovascular accident ( P <0.001), (4) carotid artery disease ( P <0.001), (5) hypertension ( P <0.001), (6) diabetes ( P =0.001), (7) age >75 years ( P =0.008), (8) moderate/severe left ventricular dysfunction ( P =0.01), (9) low cardiac output syndrome ( P <0.001), and (10) atrial fibrillation ( P <0.001). Postoperative stroke was associated with longer postoperative stay (11±4 versus 7±3 days for patients without stroke, P <0.001) and with higher in-hospital mortality (14% versus 2.7% for patients without stroke; P <0.001). Conclusions —Stroke after CABG is associated with high short-term morbidity and mortality. Increased stroke risk can be predicted by preoperative and postoperative clinical factors.

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“…Some researchers showed that even for a short period in which rSO 2 value would be under the level of 50%, this increases the duration of hospital stay, neurologic damage and impairment of cognitive functions significantly. [25][26][27] In a study regarding the use of NIRS, the patients were randomized during CABG and NIRS monitoring is applied to one group as double blind method and actively to the other group. It has been determined that the group to whom Active NIRS monitoring is applied and intervention is made as standardized, had less extended desaturations and shorter hospital stay durations and decreased vital organ mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study

Kara

Erkin

Saçlı

et al. 2015

ATCS

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IntroductionOver the years, operability criterias for cardiac surgery has been enhanced. Therefore, averege age of operated patients and co-morbidities have increased. 1) Cerebral injury is one of the most important complications of cardiac surgery which may cause mortality, morbidity, increased hospital costs and impaired quality of life. Perioperative cerebral injury includes stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients. 2) Cognitive dysfunction has been reported in approximately 50% of patients at discharge, 36% at 6 weeks, 26%-33% at one year, and 42% at five years. 3,4) Pre-exisiting atherosclerotic plaque, thrombogenesis from the foreign surfaces of cardiopulmonary bypass, air from the cardiopulmonary bypass circuit, and pericardial fat globules are tought to be primary predictors of cognitive decline by creating microemboli during Purpose: The purpose of this study was to research the use of near-infrared spectroscopy (NIRS) on the neurocognitive functions in the patients undergoing coronary artery bypass grafting (CABG) with asymptomatic carotid artery disease. Methods: The study design was carried out with the participation of 79 patients in a prospective, randomized and double blind control method. The patients were separated into two groups as NIRS (n = 43) and no NIRS (n = 36). A neurocognitive test was applied preoperatively and postoperatively to all patients before discharge. Cognitive functions were evaluated by applying the Montreal Cognitive Assessment test (MoCA). Results: The decrease in the postoperative score of mean MoCA in no NIRS group was statistically significant when compared to preoperatively (p <0.001). Postoperative mean MoCA score was found to be significantly higher in NIRS group (NIRS: 26.8 ± 1.9 vs. no NIRS: 23.6 ± 2.5, p <0.001). It has been determined that there was a moderately positive significant correlation between the increase in the NIRS used patients (%) and increase in the MoCA score of the patients (r = 0.59, p <0.001). Conclusion: Intraoperative NIRS usage in the patients undergoing CABG with carotid artery disease might be useful due to its postoperative positive effects on the cognitive functions.

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Evidence for Improved Cerebral Function After Minimally lnvasive Bypass Surgery

Abstract: Cerebral dysfunction as evidenced by ASEM errors is common following coronary bypass on-pump, but rare with off-pump bypass surgery. Cerebral microemboli generated during CPB may account for this difference.

Cited by 81 publications

References 12 publications

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Stroke After Coronary Artery Bypass

The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study

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