Impact of Embolization During Coronary Artery Bypass Grafting on Outcome and Length of Stay

Barbut, Denise; Lo, Yi Wen; Gold, Jeffrey P.; Trifiletti, Rosario Rich; Yao, Fun Sun F.; Hager, David N.; Hinton, Robert B.; Isom, O. Wayne

doi:10.1016/s0003-4975(96)01254-4

Cited by 112 publications

(68 citation statements)

References 25 publications

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“…However, quite often these signals are produced by microgaseous cavitations that can be differentiated from solid thromboembolic material detected during and shortly after cardiac surgery [26, 27]. Many HITS are detected in the MCAs and in the lumen of the aorta during and after cardiac surgery when patients are monitored using TCD and transesophageal echocardiography [41,42,43,44,45]. Most microembolic particles are recorded during clamping and unclamping of the aorta, but flurries of emboli are also detected during cannulation of the aorta and at the beginning and end of cardiac bypass.…”

Section: Imaging and Ultrasound Monitoring Data Shows That The Prevalmentioning

confidence: 99%

Is Hypoperfusion an Important Cause of Strokes? If So, How?

et al. 2006

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Traditionally hypoperfusion and embolism are considered separate important causes of stroke in patients with arterial occlusive disease. However, although hypoperfusion and embolism differ in mechanisms and location, they generally coincide in severe obstructive lesions and cause washout disturbances of embolism in low perfusion territories distal to stenosis. Unless the collateral blood supply is sufficient to prevent ischemia, multiple remote spot-like infarctions occur within the hypoperfused brain territory. In border-zone distributed infarction – long suspected to result from hemodynamic compromise alone – complementary interaction of embolisation and hypoperfusion territories has to be considered. Thus hypoperfusion with embolism or embolism alone are the most common explanations for stroke, the former often associated with less severe clinical deficits than the latter.

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Section: Imaging and Ultrasound Monitoring Data Shows That The Prevalmentioning

confidence: 99%

Is Hypoperfusion an Important Cause of Strokes? If So, How?

et al. 2006

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“…This evolution of new knowledge minimized the deleterious effects of CPB and with the addition of accessories such as arterial filters and bubble detectors; it has reduced the morbimortality in cardiac surgery procedures with CPB [38,[43][44][45]. However, the incidence, still frequent of neurological complications remains a challenge because, despite all the advances, neurologic complications still occur and are causes of serious damage [4].…”

Section: Discussionmentioning

confidence: 99%

Gaseous microemboli in cardiac surgery with cardiopulmonary bypass: the use of veno-arterial shunt as a preventive method

Reis

Menezes

Justo

2012

Revista Brasileira De Cirurgia Cardiovascular

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Neurological complications are an important cause of morbidity in the postoperative period of cardiac surgery and its incidence reaches up to 75% of patients. An important cause of these events is the formation of microbubbles in the bloodstream during cardiopulmonary bypass. Integrative review was carried out on gaseous microemboli in cardiopulmonary bypass. This study analyzed studies with different methodological approaches, but that address the issue. The result suggests the denitrogenation of blood by hyperoxia dissolved microbubbles in the blood and venoarterial shunt can balance the respiratory parameters changed with hyperoxia.Descriptors: Extracorporeal circulation. Embolism, air. Cognition disorders. Cardiac surgical procedures. ResumoAs complicações neurológicas representam importante causa de morbidade no período pós-operatório de cirurgia cardíaca e sua incidência alcança até 75% dos pacientes. Uma importante causa desses eventos é a formação de microbolhas na corrente sanguínea durante a circulação extracorpórea. Realizou-se revisão integrativa sobre microembolia gasosa na circulação extracorpórea. Esse trabalho analisou estudos com abordagens metodológicas diferentes, mas que contemplam o tema. O resultado sugere que a desnitrogenação do sangue causada pela hiperoxia dissolve microbolhas formadas no sangue e o shunt venoarterial pode equilibrar os parâmetros respiratórios alterados pela hiperoxia.Descritores: Circulação extracorpórea. Embolia aérea. Transtornos cognitivos. Procedimentos cirúrgicos cardíacos.

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“…Embolus detection by TCD or TEE has been described in virtually all patients subjected to CABG with CPB [2, 3, 4, 5, 6, 7, 8, 11]and the number of ES has been related to neurologic [7, 8]and neuropsychologic [6, 8]outcome. We hypothesized that during CABG without CPB most of the embolic sources would not exist, despite the fact that heart manipulation and lateral aortic clamping [8]still remain as possible risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Transcranial Doppler (TCD) and transesophageal echocardiography (TEE) monitoring became useful tools to detect and quantify emboli [2], and their occurrence has been particularly related to CPB techniques (bubble oxygenators and nonfiltered bypass) [3, 4, 5, 6]and also to specific operative events mainly attributable to aortic atheroma, such as insertion of aortic cannula, bypass onset and discontinuation, aortic cross-clamping and declamping [2, 7, 8]. Embolic signals (ES) have previously been described, by both methods, in most patients undergoing CABG [2, 3, 4, 5, 6, 7, 8]. The use of TEE has also been recommended to assess the severity of aortic atheroma during surgery [2].…”

Section: Introductionmentioning

confidence: 99%