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Cerebral embolization during cardiac surgery: impact of aortic atheroma burden

G B Mackensen1, L K Ti, B G Phillips-Bute

  • 1Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA.

British Journal of Anaesthesia
|October 23, 2003
PubMed

Insights

Cerebral microemboli during cardiac surgery are linked to aortic atheroma in the ascending aorta and arch. This finding may explain the increased stroke risk associated with aortic disease.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Disease

Background:

  • Aortic atheromatous disease is a known risk factor for perioperative stroke in cardiac surgery patients.
  • The relationship between cerebral microemboli and aortic atheroma burden requires further investigation.

Purpose of the Study:

  • To determine the association between cerebral microemboli and aortic atheroma burden in patients undergoing cardiac surgery.

Main Methods:

  • Transesophageal echocardiography assessed aortic atheroma burden in 128 patients.
  • Transcranial Doppler (TCD) measured cerebral embolic load during surgery.
  • Multivariate linear regression analyzed the relationship between emboli and atheroma burden.

Main Results:

  • Cerebral emboli showed a significant association with atheroma in the ascending aorta (P=0.02) and aortic arch (P=0.013) after adjusting for covariates.
  • No significant association was found between cerebral emboli and descending aortic atheroma burden (P=0.20).

Conclusions:

  • A positive relationship exists between TCD-detected cerebral emboli and atheroma burden in the ascending aorta and aortic arch.
  • The presence of significant aortic atheromatous disease may underlie the previously observed associations between cerebral emboli and adverse cerebral outcomes.
Abstract

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