A prospective observational study of emboli exposure in open versus closed chamber cardiac surgery
| Autor: | Alan Merry, Simon J Mitchell, Joseph Donnelly, Ghazwan Ns Jabur |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Ultrasonography Doppler Transcranial 030204 cardiovascular system & hematology Closed chamber law.invention 03 medical and health sciences Cerebral circulation 0302 clinical medicine 030202 anesthesiology law Internal medicine medicine Cardiopulmonary bypass Embolism Air Humans Radiology Nuclear Medicine and imaging Cardiac Surgical Procedures Stroke Advanced and Specialized Nursing Cardiopulmonary Bypass business.industry General Medicine medicine.disease respiratory tract diseases Cardiac surgery Intracranial Embolism Embolism cardiovascular system Cardiology Observational study Cardiology and Cardiovascular Medicine business Safety Research Perfusion |
| Zdroj: | Perfusion. 37:715-721 |
| ISSN: | 1477-111X 0267-6591 |
| DOI: | 10.1177/02676591211023897 |
| Popis: | Objective: Exposure to cerebral emboli is ubiquitous and may be harmful in cardiac surgery utilizing cardiopulmonary bypass. This was a prospective observational study aiming to compare emboli exposure in closed-chamber with open-chamber cardiac surgery, distinguish particulate from gaseous emboli and examine cerebral laterality in distribution. Methods: Forty patients underwent either closed-chamber procedures ( n = 20) or open-chamber procedures ( n = 20). Emboli (gaseous and solid) were detected using transcranial Doppler in both middle cerebral arteries in two monitoring phases: 1, initiation of bypass to the removal of the aortic cross-clamp; and 2, removal of aortic cross-clamp to 20 minutes after venous decannulation. Results: Total (median (interquartile range)) emboli counts (both phases) were 898 (499–1366) and 2617 (1007–5847) in closed-chamber and open-chamber surgeries, respectively. The vast majority were gaseous; median 794 (closed-chamber surgery) and 2240 (open-chamber surgery). When normalized for duration, there was no difference between emboli exposures in closed-chamber and open-chamber surgery in phase 1: 6.8 (3.6–15.2) versus 6.4 (2.0–18.1) emboli per minute, respectively. In phase 2, closed-chamber surgery cases were exposed to markedly fewer emboli than open-chamber surgery cases: 9.6 (5.1–14.9) versus 43.3 (19.7–60.3) emboli per minute, respectively. More emboli (total) passed into the right cerebral circulation: 985 (397–2422) right versus 376 (198–769) left. Conclusions: Patients undergoing open-chamber surgery are exposed to considerably higher numbers of cerebral arterial emboli after removal of the aortic cross-clamp than those undergoing closed-chamber surgery, and more emboli enter the right middle cerebral artery than the left. These results may help inform the evaluation of the pathophysiological impact of emboli exposure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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