Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli

Brown, William R.; Moody, Dixon M.; Challa, Venkata R.; Stump, David A.; Hammon, John W.

doi:10.1161/01.str.31.3.707

Cited by 206 publications

(125 citation statements)

References 48 publications

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“…Stroke is the second most common cause of mortality worldwide (1) and cerebrovascular occlusion by blood clots represents an important cause of morbidity or mortality (2). One strategy for treating stroke is to restore blood flow within the ischemic area using a thrombolytic agent such as tissue plasminogen activator (t-PA).…”

Section: Introductionmentioning

confidence: 99%

A Novel Embolic Model of Cerebral Infarction and Evaluation of Stachybotrys microspora Triprenyl Phenol-7 (SMTP-7), a Novel Fungal Triprenyl Phenol Metabolite

et al. 2010

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Abstract. The aim of the present study was to establish a novel embolic model of cerebral infarction and to evaluate the effect of Stachybotrys microspora triprenyl phenol-7 (SMTP-7), a novel fungal triprenyl phenol metabolite. Thrombotic occlusion was induced by transfer of acetic acid-induced embolus into the brain. The regional cerebral blood flow was measured by a laser Doppler flowmeter to check the ischemic condition. Infarction area was assessed by 2% 2,3,5-triphenyltetrazolium chloride (TTC) staining. Neurological scores were determined by a modified version of the method described by Longa et al. Emboli were accumulated at the temporal or parietal region of the middle cerebral artery. Additionally, we found that this model showed decreased cerebral blood flow and increased infarction area and neurological scores. Treatment with tissue plasminogen activator (t-PA) reduced infarction area and the neurological scores in a dose-dependent manner; moreover, the decreased cerebral blood flow recovered. SMTP-7 also reduced these values. The therapeutic time window of SMTP-7 was longer than that of t-PA. These results indicate that this model may be useful for understanding the pathophysiological mechanisms of cerebral infarction and evaluating the effects of therapeutic agents. Additionally, SMTP-7 is a promising approach to extend the therapeutic time window. Therefore, this novel compound may represent a novel approach for the treatment of cerebral infarction.

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Section: Introductionmentioning

confidence: 99%

A Novel Embolic Model of Cerebral Infarction and Evaluation of Stachybotrys microspora Triprenyl Phenol-7 (SMTP-7), a Novel Fungal Triprenyl Phenol Metabolite

et al. 2010

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“…Duration of CPB and AC correlates with the risk for neurologic sequelae (25), and we expected a corresponding increase of ␦P. Our data, however, showed an opposite association, excluding CPB and AC as causative factors for postoperative EEG slowing.…”

Section: Discussionmentioning

confidence: 44%

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

et al. 2005

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Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with neurologic deficits. We describe the postoperative EEG changes, assess their possible causes, and evaluate their relevance to neurologic outcome. Thirty-one children and five neonates with congenital heart disease were included. EEG recording started after intubation and continued until 22-96 h after CPB. In addition to conventional analysis, spectral analysis was performed for occipital and frontal electrodes, and differences between pre-and postoperative delta power (delta-␦P) were calculated. Maximum values of occipital delta-␦P that occurred within 48 h after CPB were correlated with clinical variables and with perioperative markers of oxidative stress and inflammation. Occipital delta-␦P correlated with frontal delta-␦P, and maximum delta-␦P correlated with conventional rating. Distinct rise of ␦P was detected in 18 of 21 children without any acute or long-term neurologic deficits but only in five of 10 children with temporary or permanent neurologic deficits. Furthermore, maximally registered delta-␦P was inversely associated with duration of CPB and postoperative ventilation. Maximal delta-␦P was also inversely associated with the loss of plasma ascorbate (as an index of oxidative stress) and plasma levels of IL-6 and IL-8. Slow wave activity frequently occurs within 48 h after CPB. However, our data do not support the notion that EEG slowing is associated with adverse neurologic outcome. This is supported by the fact that EEG slowing was associated with less oxido-inflammatory stress. Abbreviations AC, aortic cross-clamping CPB, cardiopulmonary bypass FFT, fast Fourier transformation max delta-␦P, maximum difference between pre-and postoperative delta power MDA, malondialdehyde MDA-TNL, malondialdehyde corrected for total neutral lipids ␦P, delta power delta-␦P, difference between pre-and postoperative delta power Cardiac surgery with cardiopulmonary bypass (CPB) in children and neonates is frequently associated with acute neurologic symptoms and long-term neurologic deficits (1-4). Neuropsychological deficits persist in a substantial number of patients. During the intraoperative period, a global decrease in perfusion and oxygen delivery and focal ischemia related to embolic insults or diffuse microvascular changes are the principal mechanisms of brain damage (5). Systemic inflammation and reactive oxygen species generated by CPB might contribute to postoperative neurologic dysfunction (6,7). Impaired cerebral vasoregulation and ischemia/reperfusion injury continues in the early postoperative period (8,9). Postoperative cardiopulmonary dysfunction may additionally threaten cerebral perfusion pressure and oxygen delivery. However, there is an increased energy demand to restore neuronal membrane function and ionic gradients that are compromised by CPB.Events that affect the brain are usually followed by neuronal dysfunction, which can often be detected by EEG changes.

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“…Additionally, a longer CPB time disrupts the normal functioning of kidney, nervous system, and gastrointestinal tract; thus, increases morbidity and mortality after surgery. [23][24][25][26][27][28][29] Gastrointestinal tract vascular integrity and perfusion were disrupted (i.e. sphlanchnic hypoperfusion) by a long CPB time (>90 minutes).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

Fakhri¹,

Busro²,

Rahmat³

et al. 2016

Med J Indones

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ABSTRAK (80% vs 25%, RR=5,538, p=0,006). Secara statistik, gizi kurang (86% vs 84%, RR=1,059, p=1,000), timektomi (50% vs 76%, RR=0,481, p=0,157) ABSTRACTBackground: Postsurgical sepsis is one of the main causes of the high mortality and morbidity after open congenital heart surgery in infants. This study aimed to evaluate the role of cardiopulmonary bypass duration, thymectomy, surgical complexity, and nutritional status on postsurgical sepsis after open congenital cardiac surgery in infants.

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Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli

Cited by 206 publications

References 48 publications

A Novel Embolic Model of Cerebral Infarction and Evaluation of Stachybotrys microspora Triprenyl Phenol-7 (SMTP-7), a Novel Fungal Triprenyl Phenol Metabolite

A Novel Embolic Model of Cerebral Infarction and Evaluation of Stachybotrys microspora Triprenyl Phenol-7 (SMTP-7), a Novel Fungal Triprenyl Phenol Metabolite

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

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