Cardiopulmonary Bypass at High Pressure Reduces Stroke Incidence in Patients With Tee Diagnosed Severe Aortic Atheromatous Diesase

Hartman, Gregg S.; Yao, F S; Bruefach, Mathias; Barbut, Denise; Peterson, Joshua; Charlson, Mary E.; Gold, Jeffrey P.

doi:10.1213/00000539-199504001-00051

Cited by 3 publications

(2 citation statements)

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“…Despite the suspected advantages of higher MAP, we were not able to show any advantage of higher MAP in reducing stroke in high-risk patients, which is in contrast to that shown by Hartman et al and Gold et a1. [89][90][91][92] Pulsatile Perfusion Typical CPB now incorporates nonpulsatile flow with either a roller pump or a centrifugal pump as a standard mechanism for delivering adequate cerebral perfusion. Pulsatile perfusion has long been an accepted goal of mechanical systems to more closely mimic the body's normal hemodynamic system.…”

Section: Temperature and Rewardingmentioning

confidence: 99%

Strategies to Protect the Brain During Cardiac Surgery

Newman

Stanley

Grocott

2000

Semin Cardiothorac Vasc Anesth

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Despite significant advances in cardiopulmonary by pass (CPB) technology, surgical techniques, and anes thetic management, central nervous system (CNS) com plications remain a common and costly problem after CPB. Stroke is often considered a rare and unprevent able complication of cardiac surgery. Recent studies have shown that through the use of echocardiography and historical risk stratification strategies, we can de fine which patients are at substantially greater risk for CNS injury. Through enhanced understanding of the etiology of stroke and perioperative factors, which are associated with potential for neuroprotection or injury extension, there now exists a greater potential than ever to substantially reduce neurological injury associ ated with cardiac surgery. Strategies and theories of stratifying patients at risk and secondarily reducing that risk are described, as well as consideration for early postoperative assessment to allow treatment when events occur.

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Section: Temperature and Rewardingmentioning

confidence: 99%

Strategies to Protect the Brain During Cardiac Surgery

Newman

Stanley

Grocott

2000

Semin Cardiothorac Vasc Anesth

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“…43 –54 Improvements in bypass equipment (i.e., membrane oxygenators, arterial filters) and surgical protocols to reduce the incidence of bypass-induced cognitive dysfunction have been implemented. 52,55 –62 The occurrence, however, of this adverse outcome remains substantial as demonstrated in this study. 33,35,42,54 The effect on postoperative quality of life due to the observed decline in NP performance has been shown to be a complex function of the patients' level of education and other social economic factors.…”

Section: Discussionmentioning

confidence: 48%

QEEG Changes during Cardiopulmonary Bypass: Relationship to Postoperative Neuropsychological Function

Gugino

Chabot

Aglio

et al. 1999

Clinical Electroencephalography

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The relationship of changes in intraoperative QEEG and postoperative cognitive function was studied in 32 patients undergoing cardiac surgical procedures requiring cardiopulmonary bypass (CPB). All patients were anesthetized with a high dose narcotic technique in which CPB was carried out using moderate hypothermia. EEG recorded continuously throughout each procedure was analyzed using the neurometric technique. Neuropsychological (NP) evaluations were administered to all patients before, 1 week and 2-3 months postoperatively. A decrement in postoperative performance of 2 standard deviations in two or more tests from preoperative testing was defined as a new cognitive deficit. Of the patients studied, 40.6% demonstrated a new postoperative cognitive deficit at 1 week. At 2-3 months postoperatively, 28.1% continued to show a cognitive deficit. Discriminant analysis of the QEEG as a function of NP performance was calculated at select times during the surgical procedure. QEEG prediction of NP performance was just above chance at the 1 week comparison but excellent for the 2-3 month comparisons. This study suggests that with appropriate monitoring protocols, intraoperative QEEG may predict cognitive dysfunction experienced by patients 2-3 months postoperatively.

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Cerebrovascular assessment of the high-risk patient: The role of transcranial doppler ultrasound

Doblar

1996

Journal of Cardiothoracic and Vascular Anesthesia

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Cardiopulmonary Bypass at High Pressure Reduces Stroke Incidence in Patients With Tee Diagnosed Severe Aortic Atheromatous Diesase

Cited by 3 publications

References 0 publications

Strategies to Protect the Brain During Cardiac Surgery

Strategies to Protect the Brain During Cardiac Surgery

QEEG Changes during Cardiopulmonary Bypass: Relationship to Postoperative Neuropsychological Function

Cerebrovascular assessment of the high-risk patient: The role of transcranial doppler ultrasound

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