Cerebral vascular effects of aortovenous cannulations for pediatric cardiopulmonary bypass

Rodriguez, R; Cornel, Garry; Splinter, William M.; Weerasena, Nihal; Reid, Craig W.

doi:10.1016/s0003-4975(99)01444-7

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Intraoperative NIRS monitoring is now being called for as a standard of care for cardiac surgery [23], which we would endorse. Now that monitoring the spinal cord is also feasible, we would advocate that NIRS monitoring be extended to aortic aneurysm repair and some spinal operative procedures.…”

Section: Discussionmentioning

confidence: 94%

“…NIRS monitoring of the brain and spinal cord makes it possible to identify the onset of potentially remediable adverse events in real time. Brain monitoring with NIRS is already being called for as the standard of care during cardiopulmonary bypass surgery [12,23] and observations that ischaemic damage can also be detected in the spinal cord [19] may lead to its routine use during other types of surgery where there is the potential for oxygenation of the spinal cord to be adversely affected.…”

Section: Introductionmentioning

confidence: 99%

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NIRS monitoring of brain and spinal cord — detection of adverse intraoperative events

Macnab

Gagnon

et al. 2003

Journal of Spectroscopy

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Near infrared spectroscopy (NIRS) monitors changes in oxygenated haemoglobin (HbO2), and redox status of cytochromeaa3(cyt) continuously and non-invasively in living tissue. We present examples where clinically relevant changes in HbO2and/or cyt were detected in real time, allowing intervention to avert potentially harmful hypoxic-ischaemic damage to the brain and/or spinal cord.Brain monitoring: In children undergoing surgery on cardiopulmonary bypass, observations include that: atrial fibrillation (cardiac arrhythmia) lowered cerebral HbO2concentration; concealed haemorrhage decreased cerebral HbO2concentration; inadequate level of anaesthetic resulted in spikes of changes in volume with interventions such as suturing; circulatory arrest reduced brain HbO2and cyt redox status; and bypass pump problems compromised cerebral blood flow.Spinal cord monitoring: In the experimental animal, we observed that NIRS detected ischaemic change immediately following aortic compression, spinal column distraction (instrumentation to separate the vertebrae), and hypoxia. In an infant requiring release of a congenitally tethered spinal cord, we observed that traction on the spinal cord of the infant resulted in decreased total haemoglobin concentration.Summary: NIRS brain monitoring probably represents the “standard of care” during cardiac surgery because adverse events can be detected and quantified. Similarly, spinal cord monitoring could reduce ischaemic spinal cord damage in spinal cord surgery and aortic aneurysm repair.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

NIRS monitoring of brain and spinal cord — detection of adverse intraoperative events

Macnab

Gagnon

et al. 2003

Journal of Spectroscopy

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“…There may be other more important factors that could explain it. Finally, there are other roles for TCD such as detection of the adequacy of autoregulation, detection of cerebral venous congestion [ 55 , 56 ], arterial malperfusion during aortic surgery [ 57 ] or endarterectomy [ 58 ] and its role as part of multimodal brain monitoring [ 59 , 60 ] which makes TCD a non-invasive promising routine monitoring strategy in cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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Background During cardiac surgery, transcranial Doppler (TCD) represents a non-invasive modality that allows measurement of red blood cell flow velocities in the cerebral arteries. TCD can also be used to detect and monitor embolic material in the cerebral circulation. Detection of microemboli is reported as a high intensity transient signal (HITS). The importance of cerebral microemboli during cardiac surgery has been linked to the increased incidence of postoperative renal failure, right ventricular dysfunction, and hemodynamic instability. The objective of this study is to determine whether the embolic load is associated with hemodynamic instability during cardiopulmonary bypass (CPB) separation and postoperative complications. Methods A retrospective single-centre cohort study of 354 patients undergoing cardiac surgery between December 2015 and March 2020 was conducted. Patients were divided in tertiles, where 117 patients had a low quantity of embolic material (LEM), 119 patients have a medium quantity of microemboli (MEM) and 118 patients who have a high quantity of embolic material (HEM). The primary endpoint was a difficult CPB separation. Multivariate logistic regression was used to determine the potential association between a difficult CPB separation and the number of embolic materials. Results Patients who had a difficult CPB separation had more HITS compared to patients who had a successful CPB separation (p < 0.001). In the multivariate analysis, patients with MEM decreased their odds of having a difficult CPB weaning compared to patients in the HEM group (OR = 0.253, CI 0.111–0.593; p = 0.001). In the postoperative period patients in the HEM group have a higher Time of Persistent Organ Dysfunction (TPOD), a longer stay in the ICU, a longer duration under vasopressor drugs and a higher mortality rate compared to those in the MEM and LEM groups. Conclusion The result of this study suggests that a high quantity of cerebral embolic material increases the odds of having a difficult CPB separation. Also, it seems to be associated to more complex surgery, a longer CPB time, a higher TPOD and a longer stay in the ICU. Six out of eight patients who died in this cohort were in the HEM group.

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“…These alterations tend to be transient and are often quickly compensated after each cannulation unless there is a suspected obstruction. 13 Superior vena cava decannulation, however, causes less hemodynamic stability, and the underlying cardiac lesion is often fixed during this phase. But, given these mixed findings, additional work is needed to understand in what circumstances there is a clinically meaningful difference between cerebral oxygen saturation monitors with respect to a reference value obtained from the jugular vein bulb.…”

Section: Discussionmentioning

confidence: 99%

The Correlation of Two Cerebral Saturation Monitors With Jugular Bulb Oxygen Saturation in Children Undergoing Cardiopulmonary Bypass for Congenital Heart Surgery

Naguib

Winch

Sebastian

et al. 2016

J Intensive Care Med

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Cerebral vascular effects of aortovenous cannulations for pediatric cardiopulmonary bypass

Cited by 10 publications

References 15 publications

NIRS monitoring of brain and spinal cord — detection of adverse intraoperative events

NIRS monitoring of brain and spinal cord — detection of adverse intraoperative events

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

The Correlation of Two Cerebral Saturation Monitors With Jugular Bulb Oxygen Saturation in Children Undergoing Cardiopulmonary Bypass for Congenital Heart Surgery

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