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Cerebral emboli detected during bypass surgery are associated with clamp removal
D Barbut1, R B Hinton, T P Szatrowski
1Department of Neurology, Cornell University Medical College, New York Hospital, NY 10021.
Insights
During coronary artery bypass grafting, most embolic signals occur when aortic clamps are released. This embolization, linked to aortic atheromatosis, may impact neurocognitive outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Embolic signals are detected using Transcranial Doppler ultrasonography during coronary artery bypass surgery.
- The link between embolization and specific surgical events remains unclear.
Purpose of the Study:
- To investigate the relationship between embolic signals and specific events during coronary artery bypass grafting.
- To determine the origin and potential impact of emboli during bypass surgery.
Main Methods:
- Continuous monitoring of 20 patients undergoing bypass surgery using Transcranial Doppler ultrasonography.
- Data collection from the inception to the discontinuation of bypass.
Main Results:
- Embolic signals were detected in all patients undergoing bypass.
- A significant percentage of emboli (34%) were detected during aortic cross-clamp removal and (24%) during partial occlusion clamp removal.
- Embolization rates were highest during clamp release, correlating with aortic atheromatosis severity and neurocognitive decline.
Conclusions:
- The majority of emboli during coronary artery bypass grafting are associated with aortic clamp release.
- Clamp manipulation can dislodge atheromatous debris, potentially causing emboli.
- These emboli may play a role in neurocognitive outcomes following surgery.
Background And Purpose:
Transcranial Doppler ultrasonography detects embolic signals during coronary artery bypass surgery. The relationship between embolization and specific events of bypass surgery is unclear.
Methods:
With this technique, 20 patients undergoing bypass surgery were continuously monitored from inception to discontinuation of bypass.
Results:
Embolic signals were detected in all patients. Of all embolic signals, 34% were detected as aortic cross-clamps were removed, and another 24% as aortic partial occlusion clamps were removed. Only 5% were detected at inception of bypass. Rates for embolization were 15.15 embolic signals per minute at cross-clamp removal, 10.9 embolic signals per minute at partial occlusion clamp removal, and fewer than 3 embolic signals per minute at other times. Correlation was found between the number of emboli, severity of aortic atheromatosis, and neurocognitive deterioration.
Conclusions:
The majority of emboli detected during coronary artery bypass grafting are associated with the release of clamps. Clamp manipulation may lead to release of aortic atheromatous debris. These emboli may be relevant to neurocognitive outcome.