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Macroemboli and microemboli during cardiopulmonary bypass
1Cardiothoracic Unit, Guy's Hospital, London, England.
Abstract:
Macroscopic and microscopic emboli of gas, biologic aggregates, and inorganic debris can occur during cardiac operations with cardiopulmonary bypass and may result in end-organ ischemia. In the current era pump-generated embolism is a diminishing cause of perioperative neurologic injury, which now appears to be related mostly to atheroembolism from manipulation of the atherosclerotic ascending aorta, and presents a continuing technical challenge to the surgeon.
Insights
Cardiac surgery using cardiopulmonary bypass can cause emboli leading to organ damage. However, pump-generated emboli are decreasing, with aortic atheroembolism now being the primary cause of perioperative neurologic injury.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Cardiac operations utilizing cardiopulmonary bypass can lead to emboli formation.
- These emboli, composed of gas, biologic aggregates, or inorganic debris, can cause end-organ ischemia.
- Perioperative neurologic injury is a significant concern in cardiac surgery.
Purpose of the Study:
- To analyze the causes of perioperative neurologic injury during cardiac operations.
- To evaluate the changing landscape of embolism as a cause of neurologic injury.
- To identify the primary source of neurologic injury in the current era of cardiac surgery.
Main Methods:
- Review of existing literature and surgical data.
- Analysis of embolism types and their origins.
- Correlation of embolism sources with neurologic outcomes.
Main Results:
- Pump-generated embolism is a decreasing cause of perioperative neurologic injury.
- Atheroembolism originating from the manipulation of the atherosclerotic ascending aorta is the predominant cause.
- This presents an ongoing technical challenge for surgeons.
Conclusions:
- The etiology of perioperative neurologic injury in cardiac surgery has shifted.
- Aortic atheroembolism is now the main concern, requiring specific surgical strategies.
- Minimizing aortic manipulation is crucial to prevent neurologic complications.