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Circulating microaggregates during cardiac surgery precedes postoperative stroke.

Zühre Uz1, Dan M J Milstein2, Can Ince1

  • 1Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

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Microaggregations during cardiac surgery can indicate stroke risk in elderly patients. Monitoring microcirculation offers an early warning for cerebrovascular events, undetected by standard assessments.

Keywords:
Cardiac surgeryCardiopulmonary bypassMicroaggregatesMicrocirculationStroke

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Critical Care Medicine

Background:

  • Coronary artery bypass grafting (CABG) carries risks of postoperative stroke and encephalopathy.
  • Elderly patients undergoing cardiac surgery are particularly vulnerable to cerebrovascular complications.

Observation:

  • A 78-year-old male on cardiopulmonary bypass during elective CABG exhibited sublingual microcirculatory microaggregations.
  • These microaggregations were not detected by routine intraoperative anticoagulation assessments.
  • Video microscopy identified these microaggregates prior to the patient experiencing a postoperative stroke.

Findings:

  • Postoperative imaging confirmed a left watershed cerebral infarct and carotid stenosis.
  • Intraoperative microcirculation monitoring revealed microaggregations missed by conventional methods.
  • This suggests microaggregations are a potential indicator of impending cerebrovascular events.

Implications:

  • Observing intraoperative microaggregations may serve as an early warning system for postoperative stroke in high-risk elderly patients.
  • This approach could enhance the detection of cerebrovascular event risks beyond standard anticoagulation monitoring.
  • Further research into microcirculation assessment during cardiopulmonary bypass is warranted to improve patient outcomes.