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Cerebral microembolization during antegrade selective cerebral perfusion
Hiroyuki Kamiya1, Uwe Klima, Christian Hagl
1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. hkamiya88@yahoo.co.jp
Background:
This study quantified the number of intraoperative microemboli in patients undergoing aortic arch surgery using selective cerebral perfusion (SCP) in comparison with those in patients undergoing ascending aortic replacement without circulatory arrest and SCP.
Methods:
A transcranial Doppler monitoring of the medial cerebral artery was performed in 15 patients undergoing proximal arch replacement with SCP (SCP group) and 15 patients undergoing replacement of the ascending aorta (control group).
Results:
There was no significant difference in the high-intensity transient signal counts between the SCP group and the control group at any phase. In the SCP group, 4.8% of microemboli occurred during cross-clamping, and only 0.6% occurred during SCP. In the control group, 4.6% occurred during cross-clamping. Most microemboli occurred after removing the cross-clamps in both groups; 92.2% in the SCP group and 92.1% in the control group.
Conclusions:
The present study demonstrated that outbreak frequency of microemboli during SCP was very low, and thus implies that the risk of embolic event that may be caused by SCP is very low.
Insights
Selective cerebral perfusion (SCP) during aortic arch surgery showed a very low frequency of intraoperative microemboli. This suggests a minimal risk of embolic events associated with SCP, making it a potentially safer surgical approach.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Device Monitoring
Background:
- Aortic arch surgery carries risks of cerebral complications.
- Selective cerebral perfusion (SCP) is a technique used to protect the brain during these procedures.
- Quantifying intraoperative microemboli is crucial for assessing SCP safety.
Purpose of the Study:
- To compare the incidence of intraoperative microemboli between patients undergoing aortic arch surgery with SCP and those undergoing ascending aortic replacement without SCP.
- To evaluate the safety of SCP by assessing the frequency of microembolic events.
Main Methods:
- Transcranial Doppler monitoring of the medial cerebral artery was used.
- 15 patients undergoing proximal aortic arch replacement with SCP (SCP group) were compared to 15 patients undergoing ascending aorta replacement (control group).
Main Results:
- No significant difference in microemboli counts was observed between the SCP and control groups.
- In the SCP group, only 0.6% of microemboli occurred during SCP, compared to 4.8% during cross-clamping.
- The majority of microemboli in both groups occurred after cross-clamp removal (over 92%).
Conclusions:
- The frequency of microemboli during selective cerebral perfusion is very low.
- The findings imply a low risk of embolic events associated with the use of SCP in aortic arch surgery.
- SCP appears to be a safe method for cerebral protection during aortic arch procedures.
