The Effect of Arterial Filtration on Reduction of Gaseous Microemboli in the Middle Cerebral Artery During Cardiopulmonary Bypass

Padayachee, T.S.; Parsons, S.; Theobold, R.; Gosling, R. G.; Deverall, P B

doi:10.1016/s0003-4975(10)64768-6

Cited by 127 publications

(43 citation statements)

References 12 publications

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“…These variability is due to several difference in CPB, surgical and anesthetic technique. 14 In a study of 100 patient in whom a 37% incidents of neurologic dysfunction had been diagnosed by a careful neurological examination by Kalterand his colleagues. 5 In a study done by Diedderik and his colleagues, there was some substantial neurocognitive dysfunction after cardio pulmonary bypass surgery in the early post-operative period which was less marked in off-pump procedure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

et al. 2018

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Introduction:The Neurological injury is an important complication after CABG. There is considerable evidence that early postoperative cognitive dysfunction is related to a combination of three factors often associated with CPB: (micro) embolism, hypoperfusion, and the systemic inflammatory response. Intraoperative formation of gaseous emboli and aggregated platelets, atherosclerotic debris, hypoperfusion, hypotension, hyperthermia, hyperglycaemia, surgical trauma, blood loss, Anaesthetic agents, arrhythmia and transfusion all enhance the risk of cognitive dysfunction.There are two types of Neurological injury, Type-I includes stroke, transient ischemic attack and coma and the incidence is approximately 3 to 6 percent. Type-II injury is more subtle and includes impairment of cognitive functions. These defects associated with attention, concentration, short term memory, fine motor function and speed of the mental response. The incidence of neurocognitive impairment after cardiac surgery varies from 20% to 80%. 1 Based on prospective studies, however it is apparent that the incidence of subtle postoperative neurologic and neuropsychological abnormalities is much higher, closer to 50 percent in the first week after cardiac surgery. 2 These apparent high rate of subtle neurologic impairment detected prospectively are in sharp contrast to the considerably lower incidence of stroke after cardiac surgery, reported as 1-5 percent, in several large retrospective series from different centers. 3 There are several reasons for these apparent differences in the reported incidences the timing, thoroughness and the reproducibility of the neurologic examinations, as well as the incorporation of the preoperative assessment for comparison, all determine the sensitivity and Evaluation of Neurocognitive Dysfunction afterCoronary Artery Bypass Surgery p = 0.002 and 25.93 ± 3.11 vs. 26.63 ± 2.50, p = 0.023 respectively

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Section: Discussionmentioning

confidence: 99%

Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

et al. 2018

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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%

Transesophageal Echocardiography and Transcranial Doppler Monitoring in Coronary Surgery without Cardiopulmonary Bypass: Preliminary Results

Malheiros¹,

Massaro

Carvalho

et al. 1999

Cerebrovasc Dis

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“…Arterial filters have been introduced into extracorporeal circuits for several decades to prevent solid particles and gaseous emboli from entering the patient's body during cPB procedure, and it is generally accepted that arterial filters could alleviate postoperative neurological complications in patients undergoing cPB (81,82). therefore, most heart centers conventionally utilize arterial filters in cPB circuits.…”

Section: Cpb Circuit Design and Managementmentioning

confidence: 99%

Generation, Detection and Prevention of Gaseous Microemboli during Cardiopulmonary Bypass Procedure

Lou

Liu

et al. 2011

Int J Artif Organs

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Neuropsychological injury after cardiopulmonary bypass (CPB) is one of the most serious and costly complications arising from the procedure. Gaseous microemboli (GME) have long been implicated as one of the principal causes. There are two major sources of GME: surgical and manual manipulation of the heart and arteries; and the components of the extracorporeal circuit, including the type of pump, different perfusion modes, the design of the oxygenator and reservoir, and the use of vacuum assisted venous drainage (VAVD), all of which have a great impact on the delivery of existing GME to the patients. Transcranial Cranial Doppler (TCD) has been used for more than two decades to assess and monitor the quality of extracorporeal perfusion with regard to the blood flow velocity of the middle cerebral arteries (MCA) and emboli detection, contributing to the achievement of better perfusion results. The Emboli Detection and Classification (EDAC) Quantifier has been able to detect and track microemboli in CPB circuits up to 1,000 microemboli per second at flow rates ranging from 0.2 L/min to 6.0 L/min. The deleterious effects of GME are multiple, including damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adherence, and fibrin deposition in the micro-vasculature. Improvements in perfusion equipment and in perfusion and surgical techniques have led to a dramatic reduction in the occurrence of GME during cardiac surgery. Although the clinical relevance of cerebral air embolization in causing neurological damage is unclear, every single person involved in perfusion and surgical technology should be aware of the risk of embolization and strictly regulate clinical behavior. Related research should also be done to improve the design of circuit components and clinical practice with a view to eliminating air bubbles during CPB procedure.

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The Effect of Arterial Filtration on Reduction of Gaseous Microemboli in the Middle Cerebral Artery During Cardiopulmonary Bypass

Cited by 127 publications

References 12 publications

Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

Transesophageal Echocardiography and Transcranial Doppler Monitoring in Coronary Surgery without Cardiopulmonary Bypass: Preliminary Results

Generation, Detection and Prevention of Gaseous Microemboli during Cardiopulmonary Bypass Procedure

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