Impact of the intensity of microemboli on neurocognitive outcome following cardiopulmonary bypass

Doğancı, Suat; Günaydın, Serdar; Koçak, Orhan Murat; Yılmaz, Sevda; Demirkılıç, Ufuk

doi:10.1177/0267659112470693

Cited by 25 publications

(22 citation statements)

References 17 publications

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“…In contrast is a recent publication by Doganci et al, which points at GME as a significant risk factor for cognitive disturbances. 19 Similar observations were demonstrated in a number of investigations during the mid-1990s. Detection of microemboli in the middle cerebral artery showed clear associations with postoperative cognitive deficits and the appearance of aberrant behaviour, including delirium.…”

Section: Discussionsupporting

confidence: 79%

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The scientific evidence of arterial line filtration in cardiopulmonary bypass

Johagen

Svenmarker

2016

Perfusion

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Section: Discussionsupporting

confidence: 79%

“…Microembolism during CPB is implicated as a plausible mechanism for the development of postoperative cognitive disturbances. 18,19 Even if causality seems reasonable, we lack convincing scientific evidence. 20 Future investigations will probably bring more light into this matter.…”

Section: Introductionmentioning

confidence: 99%

The scientific evidence of arterial line filtration in cardiopulmonary bypass

Johagen

Svenmarker

2016

Perfusion

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“…This difference may be related to the fact that, in addition to particulate matter, the suction-based device also extracts gaseous micro-emboli, which have been shown to affect neuropsychological functioning in cardiac surgery patients early post-operatively. 28 …”

Section: Discussionmentioning

confidence: 99%

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

Mack

Acker

Gelijns

et al. 2017

JAMA

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IMPORTANCE Stroke is a major complication of surgical aortic valve replacement. OBJECTIVE To determine the effectiveness and safety of cerebral embolic protection devices in reducing ischemic central nervous system injury during surgical aortic valve replacement DESIGN, SETTING and PARTICIPANTS A parallel-group trial conducted in 18 North American centers, randomizing patients with calcific aortic stenosis undergoing surgical aortic valve replacement between March 2015 and July 2016. INTERVENTIONS Use of one of two cerebral embolic protection devices (suction-based extraction;n=118 or intra-aortic filtration device;n=133) versus a standard aortic cannula (n=132) at the time of surgical aortic valve replacement. MAIN OUTCOMES AND MEASURES The primary endpoint was freedom from clinical or radiographic central nervous system (CNS) infarction at 7±3 days post-procedure. Secondary endpoints included a composite of clinical ischemic stroke, acute kidney injury, and death ≤30 days after surgery; delirium; mortality; serious adverse events and neurocognition. RESULTS Among 383 randomized patients (mean age 73.9, 38.4% women), freedom from CNS infarction at 7 days did not differ between suction-based extraction and controls (32.0 vs. 33.3%,difference −1.3,95%CI−13.8, 11.2) nor between intra-aortic filtration and controls (25.6% vs 32.4%, −6.9,95%CI−17.9, 4.2). Clinical stroke occurred in 5.1% suction-based extraction vs 5.8% controls (−0.7, 95%CI −6.5, 5.1) and 8.3% intra-aortic filtration vs. 6.1% controls (2.2, 95%CI −4.1, 8.4). Delirium trajectories (baseline to day 7) differed for suction-based extraction vs. control (p= 0.03) and intra-aortic filtration vs. control (p=0.02); by day 7, 6.3% of suction-based extraction vs 15.3% of control patients (−9.1, 95%CI −17.1, −1.0), and 8.1% of intra-aortic filtration vs 15.6% of control patients (−7.4, 95%CI−15.5, 0.6) experienced delirium. The 30-day composite endpoint did not differ between suction-based extraction and controls (21.4% vs 24.2%; −2.8, 95%CI −13.5,7.9) nor between intra-aortic filtration and controls (33.3% vs 23.7%; 9.7, 95%CI −1.2,20.5). Neurocognitive outcomes were not different between groups except for less decline in executive function in intra-aortic filtration vs controls (p=0.05). CONCLUSIONS AND RELEVANCE The incidence of CNS infarction after surgical aortic valve replacement was not altered by either embolic protection device. Potential benefits for delirium reduction, cognition and symptomatic stroke merit larger trials with longer follow-up.

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“…Gaseous microemboli remain an important challenge in CPB procedures because of the significant positive correlation between microemboli exposure during CPB and postoperative neurological injury [21] . Thus, minimizing the number of GME delivered to pediatric patients undergoing CPB procedures should lead to better clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

In-Vitro Evaluation of Two Types of Neonatal Oxygenators in Handling Gaseous Microemboli and Maintaining Optimal Hemodynamic Stability During Cardiopulmonary Bypass

Marupudi¹,

Wang²,

Canêo³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveUsually only FDA-approved oxygenators are subject of studies by the international scientific community. The objective of this study is to evaluate two types of neonatal membrane oxygenators in terms of transmembrane pressure gradient, hemodynamic energy transmission and gaseous microemboli capture in simulated cardiopulmonary bypass systems.MethodsWe investigated the Braile Infant 1500 (Braile Biomédica, São José do Rio Preto, Brazil), an oxygenator commonly used in Brazilian operating rooms, and compared it to the Dideco Kids D100 (Sorin Group, Arvada, CO, USA), that is an FDA-approved and widely used model in the USA. Cardiopulmonary bypass circuits were primed with lactated Ringer's solution and packed red blood cells (Hematocrit 40%). Trials were conducted at flow rates of 500 ml/min and 700 ml/min at 35ºC and 25ºC. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For gaseous microemboli testing, 5cc of air were manually injected into the venous line. Gaseous microemboli were recorded using the Emboli Detection and Classification Quantifier.ResultsBraile Infant 1500 had a lower pressure drop (P<0.01) and a higher total hemodynamic energy delivered to the pseudopatient (P<0.01). However, there was a higher raw number of gaseous microemboli seen prior to oxygenator at lower temperatures with the Braile oxygenator compared to the Kids D100 (P<0.01).ConclusionBraile Infant 1500 oxygenator had a better hemodynamic performance compared to the Dideco Kids D100 oxygenator. Braile had more gaseous microemboli detected at the pre-oxygenator site under hypothermia, but delivered a smaller percentage of air emboli to the pseudopatient than the Dideco oxygenator.

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Impact of the intensity of microemboli on neurocognitive outcome following cardiopulmonary bypass

Abstract: Correlation between intraoperative GME intensity and neurocognitive tests suggests that the level of GME might have a role in determining the psychological outcome after CABG with CPB.

Cited by 25 publications

References 17 publications

The scientific evidence of arterial line filtration in cardiopulmonary bypass

The scientific evidence of arterial line filtration in cardiopulmonary bypass

Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement

In-Vitro Evaluation of Two Types of Neonatal Oxygenators in Handling Gaseous Microemboli and Maintaining Optimal Hemodynamic Stability During Cardiopulmonary Bypass

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