Stroke, Vol 25, 1393-1399, Copyright © 1994 by American Heart Association
W Pugsley, L Klinger, C Paschalis, T Treasure, M Harrison and S Newman
BACKGROUND AND PURPOSE: Microemboli have been implicated in the etiology of
neuropsychological deficits after cardiopulmonary bypass. This study
examined the incidence of high-intensity transcranial signals (microemboli)
and their relation to changes in neuropsychological performance after
surgery. METHODS: Transcranial Doppler ultrasonography was used to measure
middle cerebral artery blood flow velocity and detect microemboli. The
number of high- intensity transcranial signals was determined and related
to a neurological examination and absolute changes in neuropsychological
performance as well as the number of patients considered to exhibit a
neuropsychological deficit. Data were available on 100 consenting patients
undergoing routine cardiopulmonary bypass. Fifty of the patients were
randomly assigned to a procedure that included a 40- microns arterial line
filter, and 50 had the procedure without any arterial line filter. RESULTS:
Significantly more patients were found to have neuropsychological deficits
in the group without the arterial line filter at both 8 days (P < .05)
and 8 weeks (P < .03) after surgery. In addition, more "soft"
neurological signs were found in the nonfiltered group 24 hours after
surgery (P < .05). More high-intensity transcranial signals were found
in the nonfiltered group, and the number of high-intensity transcranial
signals was found to be related to the likelihood of a patient having a
neuropsychological deficit at 8 weeks. CONCLUSIONS: These data suggest that
neuropsychological deficits after routine cardiopulmonary bypass are
related to the number of microemboli delivered during surgery. Furthermore,
the numbers of microemboli may be reduced by including a 40-microns filter
on the arterial line.
ARTICLES
The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning
Department of Psychiatry, University College London Medical School, Middlesex Hospital, England.
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P. Svenarud, M. Persson, and J. van der Linden Effect of CO2 Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery: A Randomized Clinical Trial Circulation, March 9, 2004; 109(9): 1127 - 1132. [Abstract] [Full Text] [PDF]
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R. Motallebzadeh, R. Kanagasabay, M. Bland, J. C. Kaski, and M. Jahangiri S100 protein and its relation to cerebral microemboli in on-pump and off-pump coronary artery bypass surgery Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 409 - 414. [Abstract] [Full Text] [PDF]
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D. C. Whitaker, S. P. Newman, J. Stygall, C. Hope-Wynne, M. J.G. Harrison, and R. K. Walesby The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 2004; 25(2): 267 - 274. [Abstract] [Full Text] [PDF]
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T. Sakamoto, H. Kurosawa, T. Shin'oka, M. Aoki, and Y. Isomatsu The influence of pH strategy on cerebral and collateral circulation during hypothermic cardiopulmonary bypass in cyanotic patients with heart disease: Results of a randomized trial and real-time monitoring J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 12 - 19. [Abstract] [Full Text] [PDF]
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J. Bucerius, J. F. Gummert, M. A. Borger, T. Walther, N. Doll, V. Falk, D. V. Schmitt, and F. W. Mohr Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 57 - 64. [Abstract] [Full Text] [PDF]
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M. Saqqur, N. Dean, M. Schebel, M. D. Hill, A. Salam, A. Shuaib, and A. M. Demchuk Improved Detection of Microbubble Signals Using Power M-Mode Doppler Stroke, January 1, 2004; 35 (1): e14 - e17. [Abstract] [Full Text] [PDF]
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V. Dalinin, P. S. Lingaas, K. Hatteland, and J. L Svennevig Carotid Doppler microembolic signals in patients one year after heart valve surgery Perfusion, December 1, 2003; 18(6): 333 - 337. [Abstract] [PDF]
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 D. W. Droste, T. Beyna, B. Frye, V. Schulte, E. B. Ringelstein, and R. M. Schaefer Reduction of circulating microemboli in the subclavian vein of patients undergoing haemodialysis using pre-filled instead of dry dialysers Nephrol. Dial. Transplant., November 1, 2003; 18(11): 2377 - 2381. [Abstract] [Full Text] [PDF]
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G. B. Mackensen, L. K. Ti, B. G. Phillips-Bute, J. P. Mathew, M. F. Newman, H. P. Grocott, and the Neurologic Outcome Research Group Cerebral embolization during cardiac surgery: impact of aortic atheroma burden Br. J. Anaesth., November 1, 2003; 91(5): 656 - 661. [Abstract] [Full Text] [PDF]
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M. Schoenburg, B. Kraus, A. Muehling, U. Taborski, H. Hofmann, G. Erhardt, S. Hein, M. Roth, P. R. Vogt, G. F. Karliczek, et al. The dynamic air bubble trap reduces cerebral microembolism during cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1455 - 1460. [Abstract] [Full Text] [PDF]
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J. E. Scarborough, W. White, F. E. Derilus, J. P. Mathew, M. F. Newman, and K. P. Landolfo Combined use of off-pump techniques and a sutureless proximal aortic anastomotic device reduces cerebral microemboli generation during coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1561 - 1567. [Abstract] [Full Text] [PDF]
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C. W. Hogue Jr, R. Lillie, T. Hershey, S. Birge, A. M. Nassief, B. Thomas, and K. E. Freedland Gender influence on cognitive function after cardiac operation Ann. Thorac. Surg., October 1, 2003; 76(4): 1119 - 1125. [Abstract] [Full Text] [PDF]
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M. V Kalpokas, I. K Nixon, R. Kluger, D. S Beilby, and B. S Silbert Carbon dioxide field flooding versus mechanical de-airing during open-heart surgery: a prospective randomized controlled trial Perfusion, September 1, 2003; 18(5): 291 - 294. [Abstract] [PDF]
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M. Perthel, S. Kseibi, A. Bendisch, and J. Laas The dynamic bubble trap reduces microbubbles in extracorporeal circulation and high intensity transient signals in the middle cerebral artery: a case report Perfusion, September 1, 2003; 18(5): 325 - 329. [Abstract] [PDF]
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J. H. Rapp, X. M. Pan, B. Yu, R. A. Swanson, R. T. Higashida, P. Simpson, and D. Saloner Cerebral Ischemia and Infarction From Atheroemboli <100 {micro}m in Size Stroke, August 1, 2003; 34(8): 1976 - 1980. [Abstract] [Full Text] [PDF]
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T. Ueno, Y. Iguro, H. Yamamoto, R. Sakata, Y. Kakihana, and K. Nakamura Serial measurement of serum S-100B protein as a marker of cerebral damage after cardiac surgery Ann. Thorac. Surg., June 1, 2003; 75(6): 1892 - 1897. [Abstract] [Full Text] [PDF]
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T. Goto, T. Baba, K. Matsuyama, K. Honma, M. Ura, and T. Koshiji Aortic atherosclerosis and postoperative neurological dysfunction in elderly coronary surgical patients Ann. Thorac. Surg., June 1, 2003; 75(6): 1912 - 1918. [Abstract] [Full Text] [PDF]
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A. E. Jewell, E. F. Akowuah, S. K. Suvarna, P. Braidley, D. Hopkinson, and G. Cooper A prospective randomised comparison of cardiotomy suction and cell saver for recycling shed blood during cardiac surgery Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 633 - 636. [Abstract] [Full Text] [PDF]
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D. J. Cook, T. A. Orszulak, K. J. Zehr, N. A. Nussmeier, J. J. Livesay, J. W. Hammon, and X. Chen Effectiveness of the Cobra aortic catheter for dual-temperature management during adult cardiac surgery J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 378 - 384. [Abstract] [Full Text] [PDF]
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J. P. Mathew, H. P. Grocott, B. Phillips-Bute, M. Stafford-Smith, D. T. Laskowitz, D. Rossignol, J. A. Blumenthal, and M. F. Newman Lower Endotoxin Immunity Predicts Increased Cognitive Dysfunction in Elderly Patients After Cardiac Surgery Stroke, February 1, 2003; 34(2): 508 - 513. [Abstract] [Full Text] [PDF]
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J. Laas, S. Kseibi, M. Perthel, A. Klingbeil, L'E. El-Ayoubi, and A. Alken Impact of high intensity transient signals on the choice of mechanical aortic valve substitutes Eur. J. Cardiothorac. Surg., January 1, 2003; 23(1): 93 - 96. [Abstract] [Full Text] [PDF]
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E. A. Hessel II and L. H. Edmunds Jr. Extracorporeal Circulation: Perfusion Systems Card. Surg. Adult, January 1, 2003; 2(2003): 317 - 338. [Full Text]
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T. W. Willcox and R. van Uden Best Practice for Cardiopulmonary Bypass in the High-Risk Elderly Patient Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 293 - 300. [Abstract] [PDF]
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S. Urbanek and H.-J. Tiedtke Improved methods for measurement of gaseous microbubbles during extracorporeal circulation Perfusion, December 1, 2002; 17(6): 429 - 434. [Abstract] [PDF]
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T. J. Jones, D. D. Deal, J. C. Vernon, N. Blackburn, and D. A. Stump Does vacuum-assisted venous drainage increase gaseous microemboli during cardiopulmonary bypass? Ann. Thorac. Surg., December 1, 2002; 74(6): 2132 - 2137. [Abstract] [Full Text] [PDF]
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L. Restrepo, R. J. Wityk, M. A. Grega, L. Borowicz Jr, P. B. Barker, M. A. Jacobs, N. J. Beauchamp, A. E. Hillis, and G. M. McKhann Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging of the Brain Before and After Coronary Artery Bypass Grafting Surgery Stroke, December 1, 2002; 33(12): 2909 - 2915. [Abstract] [Full Text] [PDF]
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