Low perfusion pressure during CPB may induce cerebral metabolic and ultrastructural changes

Farstad, Mikael; Myklebust, R.; Kvalheim, Venny Lise; Hammersborg, Stig; Husby, Paul

doi:10.1080/14017430701393218

Cited by 4 publications

(2 citation statements)

References 102 publications

(111 reference statements)

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“…Use of off-pump surgery and a no-touch aorta technique in the case of diseased ascending aorta, 28,29 improving CPB techniques and materials, 30 reducing CPB and aorta clamping times, 31 and avoidance of intraoperative hypoperfusion, 32 are measures which may significantly reduce the risk of postoperative CVA.…”

Section: Discussionmentioning

confidence: 99%

Stroke after Coronary Artery Surgery: A Single Center Report

AlWaqfi

Ibrahim

2014

Int J Angiol

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Stroke or cerebrovascular accident (CVA) is a devastating complication of coronary surgery. In this report, the incidence, and correlates of CVA following isolated coronary artery bypass grafting (CABG) surgery were evaluated. Data were collected retrospectively. Between 2006 and 2009, 855 patients underwent isolated CABG surgery. CVA was defined as any new neurological deficit lasting more than 24 hours. Univariate and multivariate analyses were utilized as appropriate. The incidence of CVA was 1.4% (n = 12). Age, previous CVA, and emergency surgery were correlated by univariate analysis. Multivariate analysis revealed age, previous CVA, and chronic renal impairment as predictors of CVA. Ten (83.3%) of the 12 patients were diagnosed to have CVA in the first 24 hours. Length of hospital stay was 20.9 ± 20.34 days for CVA patients and 9.2 ± 5.17 days for non-CVA patients (p ≤ 0.001). There were 4 (33.3%) deaths in CVA group and 27 (3.2%) for non-CVA patients (p = 0.001). Postoperative CVA is a major contributor to mortality, prolonged hospitalization, and other adverse postoperative complications. Further studies are needed to develop better strategies to minimize the occurrence of CVA among patients undergoing CABG.

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Section: Discussionmentioning

confidence: 99%

Stroke after Coronary Artery Surgery: A Single Center Report

AlWaqfi

Ibrahim

2014

Int J Angiol

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“…Haugen et al [15], found biochemical and morphologic changes consistent with hypoperfusion and anaerobic metabolism when MAP decreased below 40 mmHg and CPP below 30 mmHg during hypothermic (28°C) cardiopulmonary bypass. In the present study, however, the L/P-ratio remained within normal range.…”

Section: Discussionmentioning

confidence: 99%

Brain changes in Hypothermia: Surface-versus Core-cooling in pigs

Morild¹

2017

J Forensic Sci Res

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The process of hypothermia in the clinical setting has been practiced for 50 years and is known for its neuroprotective properties. This paper describes histopathological changes either by an ice sludge mimicking accidental hypothermia (S-group n=7) or by endovascular core-cooling (C-group n=7). Focal infi ltrates of neutrophilic granulocytes were found in fi ve of seven brains in the S-group and in one of seven brains in the C-group. These granulocytes were found in the arachnoids, in vessels, in vessel walls, and in the cerebral cortex. Fungi, bacteria, lymphocytes or plasma were not found.This experimental study, mimicking accidental hypothermia, reported histopathologic features of aseptic infl ammation. To our knowledge, such fi ndings have not been described in hypothermic animals or humans before. We suggest that a local infl ammatory response may be triggered in such cases of hypothermia.

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Outcomes XIII: Denouement

Landis

Murkin²,

Stump³

et al. 2010

The Heart Surgery Forum

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The lack of established cause and effect between putative mediators of inflammation and adverse clinical outcomes has been responsible for many failed anti-inflammatory interventions in cardiopulmonary bypass (CPB). Candidate interventions that impress in preclinical trials by suppressing a given inflammation marker might fail at the clinical trial stage because the marker of interest is not linked causally to an adverse outcome. Alternatively, there exist examples in which pharmaceutical agents or other interventions improve clinical outcomes but for which we are uncertain of any antiinflammatory mechanism. The Outcomes consensus panel made 3 recommendations in 2009 for the conduct of clinical trials focused on the systemic inflammatory response. This panel was tasked with updating, as well as simplifying, a previous consensus statement. The present recommendations for investigators are the following: (1) Measure at least 1 inflammation marker, defined in broad terms; (2) measure at least 1clinical end point, drawn from a list of practical yet clinically meaningful end points suggested by the consensus panel; and(3) report a core set of CPB and perfusion criteria that maybe linked to outcomes. Our collective belief is that adhering to these simple consensus recommendations will help define the influence of CPB practice on the systemic inflammatory response, advance our understanding of causal inflammatory mechanisms, and standardize the reporting of research findings in the peer-reviewed literature.

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Low perfusion pressure during CPB may induce cerebral metabolic and ultrastructural changes

Abstract: MAP below 45 mmHg during CPB was associated with cerebral biochemical and morphological changes consistent with anaerobic metabolism and subcellular injury.

Cited by 4 publications

References 102 publications

Stroke after Coronary Artery Surgery: A Single Center Report

Stroke after Coronary Artery Surgery: A Single Center Report

Brain changes in Hypothermia: Surface-versus Core-cooling in pigs

Outcomes XIII: Denouement

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