TITLE

Microemboli and Cerebral Impairment During Cardiac Surgery

AUTHOR(S)
Pugsley, W.; Klinger, L.; Paschalis, C.; Aspey, B.; Newman, S.; Harrison, M.; Treasure, T.
PUB. DATE
January 1990
SOURCE
Vascular Surgery;Jan/Feb1990, Vol. 24 Issue 1, p34
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Arterial microemboli, which may be reduced by arterial line filtration, have been proposed as a factor contributing to cardiopulmonary bypass (CPB)-related cerebral dysfunction. The authors report on a study investigating the effects of arterial line filtration on the incidence of microemboli and the neuropsychological outcome in patients undergoing coronary artery surgery. Patients were randomized to filtered (40 micron) and nonfiltered CPB. Change from preoperative neuropsychological performance was assessed eight weeks after surgery by a battery of ten tests plus a mood state assessment. Perfusion technique (pressure > 50mmHg, flow 1.8-2.4L/m2/min) was standardized and continuously monitored. Transcranial Doppler measured middle cerebral artery blood velocity and the incidence of microembolic events (MEE). Forty patients (median age fifty-six years, range forty-three to seventy) have completed the protocol. MEE occurred in all patients during aortic cannulation and at inception of bypass. During bypass, patients with filtered CPB bad fewer MEE (0-10 per thirty minutes) than nonfiltered CPB patients (30-> 250 per thirty minutes) did. Seven of 20 nonfiltered CPB patients showed soft neurologic signs on the first postoperative day compared with 3/20 in the filtered CPB group (P=0.27, Fisher's). The filtered CPB patients performed better on a verbal memory test (P<0.01, Wilcoxon) at eight weeks than the nonfiltered CPB group did.
ACCESSION #
16741419

 

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