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Published on: September 22, 2020
Transcranial Doppler emboli count predicts rise in creatinine after coronary artery bypass graft surgery
Gautam M Sreeram1, Hilary P Grocott, William D White
1Department of Anesthesiology, Duke Heart Center, Duke University Medical Center, Durham, NC, USA. sreer001@mc.duke.edu
Insights
Higher numbers of emboli detected by transcranial Doppler ultrasonography during coronary artery bypass graft surgery correlate with increased risk of postoperative renal dysfunction.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Neurosonology
Background:
- Coronary artery bypass graft (CABG) surgery often involves cardiopulmonary bypass (CPB).
- Emboli, or small masses, can form during CPB and travel to the brain or kidneys.
- Postoperative renal dysfunction is a significant complication following CABG surgery.
Purpose of the Study:
- To investigate the association between emboli detected via transcranial Doppler ultrasonography (TCD) during CABG surgery and the development of postoperative renal dysfunction.
- To quantify the relationship between the number of emboli and the change in serum creatinine levels.
Main Methods:
- Retrospective analysis of 286 patients undergoing CABG surgery at a tertiary care university hospital.
- Transcranial Doppler ultrasonography of the right middle cerebral artery was used to detect and count emboli during surgery.
- Renal dysfunction was measured by the change in serum creatinine (Delta-Cr) from preoperative to maximum postoperative levels.
Main Results:
- A significant univariate correlation was found between the total number of TCD-detected emboli and postoperative Delta-Cr (p = 0.0003).
- This association remained significant in multivariable analysis, even after adjusting for various clinical and surgical factors (p = 0.0038).
- Factors adjusted for included age, sex, CPB time, and pre-existing conditions like diabetes and hypertension.
Conclusions:
- Increased numbers of emboli detected by TCD during CABG surgery are significantly associated with postoperative renal dysfunction.
- TCD monitoring may help identify patients at higher risk for renal complications after CABG.
- Further research could explore strategies to reduce emboli formation during CPB.
Objective:
To examine the correlation between transcranial Doppler ultrasonography-detected emboli during coronary artery bypass graft surgery with cardiopulmonary bypass and renal dysfunction as determined by the postoperative change in creatinine.
Design:
Retrospective review of data from the anesthesia and cardiothoracic surgery databases.
Setting:
Tertiary care university hospital.
Participants:
Two hundred eighty-six patients undergoing coronary artery bypass graft surgery.
Interventions:
Transcranial Doppler ultrasonography of the right middle cerebral artery was performed after induction of general anesthesia through completion of the operation. Doppler signals were recorded and emboli counts determined using an automated counting system.
Measurements And Main Results:
Renal dysfunction was assessed as the change in creatinine from the preoperative value to the maximum postoperative value (Delta-Cr). There was a significant (p = 0.0003) univariate correlation between postoperative change in creatinine and total number of Doppler-detected emboli. The effect of total number of emboli remained significant (p = 0.0038) in the multivariable analysis after adjustment for covariables (age, sex, number of grafts, left ventricular ejection fraction, hypertension, history of congestive heart failure, diabetes, cardiopulmonary bypass time, preoperative creatinine, and maximum postoperative creatinine).
Conclusions:
Increased numbers of Doppler-detected emboli during coronary artery bypass graft surgery are associated with postoperative renal dysfunction.
