Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass

Moraca, Robert J.; Lin, Eugene C.; Holmes, James H.; Fordyce, David J.; Campbell, William; Ditkoff, Mary; Hill, Mark; Guyton, Steven W.; Paull, Daniel L.; Hall, Richard

doi:10.1016/j.jtcvs.2005.10.046

Cited by 39 publications

(33 citation statements)

References 18 publications

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“…[8] Diğer yandan kardiyak cerrahi sırasında serebral oksimetre desatürasyon sıklığı özellikle pediatrik hastalarda ve aort cerrahisinde yüksek bulunmuştur [9,10] . Çoklu cerrahi operasyon geçiren, ileri yaşlı ve serebrovasküler hastalığı olan olgularda serebral oksimetre monitörizas-yonunun potansiyel yararı olduğu gösterilmiştir [11,12] . Ancak Douds ve ark.…”

Section: Discussionunclassified

Monitorisation of Cerebral Oxygenation in Cardiac Surgeries with and Without Cardiotomy

Türkyılmaz¹,

Karadeniz²,

Demir³

et al. 2017

GKDA Derg

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Section: Discussionunclassified

Monitorisation of Cerebral Oxygenation in Cardiac Surgeries with and Without Cardiotomy

Türkyılmaz¹,

Karadeniz²,

Demir³

et al. 2017

GKDA Derg

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“…This may have implications for current practices that include increasing proportions of elderly patients with cerebrovascular disease. 10,11 Continuous cerebral blood flow autoregulation monitoring as used in this study provides an individual estimate of autoregulation based on fluctuations in MAP that occur during the course of surgery. This approach allows perhaps for a more precise determination of the LLA than discrete and intermittent measurements.…”

Section: Discussionmentioning

confidence: 99%

“…Our observations suggest that a MAP in the usual clinical range of 50 to 70 mmHg during CPB might result in cerebral blood flow being pressure passive in some patients predisposing to cerebral hypoperfusion. 10,11 At the same time, maintaining empirically high MAP targets may unnecessarily expose some patients with a low LLA to higher cerebral blood flow potentially increasing cerebral embolic load and predisposing to cerebral edema. 5,32 Transcranial Doppler monitoring during cardiac surgery is associated with many known limitations including the need to frequently readjust the transducer and interference from electric cautery.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] Importantly, whether the practice of targeting low MAP during CPB is appropriate for the increasing number of elderly patients with cerebral vascular disease is not known. 10,11 Our group, in fact, has found a high frequency of hypoperfusion type "watershed" strokes after cardiac surgery that were associated with MAP during CPB that was ≥ 10 mmHg lower than before CPB. 11 Real-time autoregulation monitoring can be accomplished by the continuous calculation of the correlation between transcranial Doppler-measured cerebral blood flow velocity of the middle cerebral artery and cerebral perfusion pressure (termed mean velocity index).…”

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confidence: 95%

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Predicting the Limits of Cerebral Autoregulation During Cardiopulmonary Bypass

Joshi¹,

Ono²,

Brown³

et al. 2012

Survey of Anesthesiology

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Background-Mean arterial blood pressure (MAP) targets are empirically chosen during cardiopulmonary bypass (CPB). We have previously shown that near-infrared spectroscopy (NIRS) can be used clinically for monitoring cerebral blood flow autoregulation. The hypothesis of this study was that real-time autoregulation monitoring using NIRS-based methods is more accurate for delineating the MAP at the lower limit of autoregulation (LLA) during CPB than empiric determinations based on age, preoperative history, and preoperative blood pressure.

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“…Further, 75% of patients undergoing CABG surgery were found to have cerebral perfusion abnormalities using SPECT imaging before surgery. 74 36,37 In an analysis of data of patients who had diffusion-weighted MRI for stroke after cardiac surgery, 68% were found to have "watershed" strokes occurring at the borderzone between cerebral vascular territories ( Figure 1). A reduction in MAP during CPB of ≥ 10 mmHg from baseline was associated with a 4.05 times increased odds (95% CI 1.03, 15.98) for bilateral watershed strokes.…”

Section: Cerebral Hypoperfusionmentioning

confidence: 99%

Mechanisms of Cerebral Injury from Cardiac Surgery

Hogue

Gottesman

Stearns

2008

Critical Care Clinics

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Cerebral injury is a frequent complication of cardiac surgery and has been associated with high mortality, morbidity, hospital costs, and an increased likelihood of admission to a secondary care facility after hospital discharge, and impaired quality of life. 47,71,78,86 There are a variety of manifestations of perioperative cerebral injury including ischemic (or, less commonly, hemorrhagic) stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients, and neurocognitive dysfunction affecting 20% to 30% of patients one month after surgery. 47,71,78,86 The range in reported incidences between studies is likely due to different patient populations (e.g., patient age and risk status, types of procedures), diagnostic definitions, and the intensity of clinical surveillance. Contemporary studies using sensitive brain MRI with diffusion weighted imaging report that as many as 45% of patients who have undergone cardiac surgery have new ischemic brain lesions that are often clinically undetected. 47,63The prevailing hypothesis, though not definitively proven, is that all forms of injury associated with cardiac surgery (i.e., stroke, encephalopathy, and neurocognitive dysfunction) have a similar etiology and that the manifestations depend on the extent and location of brain injury (e.g., motor cortex vs. areas subserving cognition). Many earlier studies that have described long-term neurocognitive changes after cardiac surgery have failed to include a non-surgical control group. 47,79 In a longitudinal study of patients with coronary artery disease undergoing either percutaneous coronary interventions or coronary artery bypass grafting (CABG), there were no differences in cognitive measures 36 months after either procedure. 88 These data imply that the effects of cardiac surgery on cognition may be short-lived (i.e., ~ 3 mo) and that progression of inherent cerebral vascular disease is a more important determinant of long-term cognitive decrements. These results further underscore the low sensitivity and specificity of psychometric testing for detecting cerebral injury in elderly populations with a high prevalence of preexisting cognitive impairment. 47In this paper, we will examine postulated mechanisms for cerebral injury from cardiac surgery. Most emphasis has been placed in the past on the intraoperative interval as being the period of highest cerebral vulnerability. Many clinical cerebral events, however, occur in the postoperative period. We have reported, in fact, that > 20% of clinical strokes occur after recovery from surgery and anesthesia. 45,71 Thus, patients must be considered vulnerable to cerebral injury any time during the perioperative period.

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Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass

Abstract: Seventy-five percent of patients undergoing coronary bypass grafting have a significant impairment in regional cerebral perfusion compared with published age-matched controls, which may contribute to their proclivity for cerebral complications.

Cited by 39 publications

References 18 publications

Monitorisation of Cerebral Oxygenation in Cardiac Surgeries with and Without Cardiotomy

Monitorisation of Cerebral Oxygenation in Cardiac Surgeries with and Without Cardiotomy

Predicting the Limits of Cerebral Autoregulation During Cardiopulmonary Bypass

Mechanisms of Cerebral Injury from Cardiac Surgery

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