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When do cerebral emboli appear during open heart operations? A transcranial Doppler study
J van der Linden1, H Casimir-Ahn
1Department of Anesthesia and Intensive Care, University Hospital, Uppsala, Sweden.
The Annals of Thoracic Surgery
|February 1, 1991
Summary
Cerebral air emboli occur in all open-heart surgeries despite deairing. These emboli are most common when the heart restarts pumping after cardiopulmonary bypass, highlighting risks during blood redistribution.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Devices
Background:
- Cerebral air embolism is a risk during open-heart surgery.
- Standard deairing procedures aim to prevent air embolism.
- Monitoring cerebral blood flow during surgery is crucial.
Purpose of the Study:
- To detect cerebral air emboli during open-heart valve operations using transcranial Doppler.
- To identify specific surgical events associated with air embolism.
- To evaluate the effectiveness of standard deairing procedures.
Main Methods:
- Transcranial Doppler (TCD) monitoring of the middle cerebral artery.
- Continuous monitoring during aortic or mitral valve replacement.
- Observation during various stages of cardiopulmonary bypass and aortic manipulation.
Main Results:
- Cerebral air emboli were detected in all 10 patients.
- Emboli occurred during aortic cannula insertion, bypass initiation, and heart re-perfusion.
- No emboli were detected during aortic cross-clamping.
- Significant emboli were observed during the filling of the empty beating heart.
Conclusions:
- Standard deairing is insufficient to prevent cerebral air emboli in open-heart surgery.
- The highest risk of emboli occurs during blood redistribution when the heart begins active ejection.
- Recommendations include meticulous deairing before aortic declamping and considering strategies to reduce emboli incidence.