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Cerebral embolisation during modern cardiopulmonary bypass
1University Hospital of South Manchester, West Didsbury, Manchester M20 2LR, UK. cnmcc@fs1.with.man.ac.uk
Summary
Cerebral embolisation is common during coronary artery bypass surgery, even with modern bypass technology. Aortic manipulation during surgery contributes to emboli, but imaging did not predict this risk.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Cerebral microembolisation is a known complication of cardiopulmonary bypass.
- It can lead to stroke and cognitive impairment after surgery.
- Modern bypass technology aims to reduce these risks.
Purpose of the Study:
- To investigate the frequency of cerebral embolisation during coronary artery bypass surgery.
- To correlate cerebral embolisation with ascending aortic atherosclerosis.
- To assess the predictive value of imaging for emboli generation.
Main Methods:
- Transcranial Doppler monitoring for cerebral emboli in 65 patients undergoing coronary artery bypass surgery.
- Non-pulsatile alpha-stat hypothermic bypass was used.
- Epicardial ultrasound imaging of the ascending aorta was performed in 14 patients.
Main Results:
- Over half of patients (56.9%) experienced more than 200 cerebral emboli.
- Emboli were most frequent at bypass initiation and defibrillation.
- Aortic manipulation (clamping, cannulation) generated significant particulate emboli.
- Mild aortic atherosclerosis did not correlate with emboli numbers.
Conclusions:
- Cerebral embolisation is still frequent during coronary artery bypass surgery.
- Aortic manipulation is a source of emboli.
- Epicardial ultrasound imaging was not helpful in predicting emboli from aortic manipulation.