Retinal and Cerebral Microembolization During Coronary Artery Bypass Surgery

Abstract

Background-We sought to compare the effects on ophthalmic function of coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and off-pump (OPCAB) grafting and to investigate whether retinal microvascular damage is associated with markers of cerebral injury. Methods and Results-Retinal microvascular damage was assessed by fluorescein angiography and color fundus photography. Ophthalmic function was tested by the logarithm of the minimum angle of resolution visual acuity (VA), and cerebral injury, by transcranial Doppler ultrasound-detected emboli and S100 protein values. Twenty patients were randomized. Fluorescein angiography and postoperative VA could not be obtained for 1 CABG-CPB patient. Retinal microvascular damage was detected in 5 of 9 CABG-CPB but in none of 10 OPCAB patients (risk difference, 55%; 95% confidence interval [CI], 23% to 88%; Pϭ0.01). Color fundus photography detected microvascular damage in 1 CABG-CPB patient but in no OPCAB patients; this lesion was associated with a field defect, which remained after 3 months of follow-up. There was no difference in postoperative VA. Doppler high-intensity transient signals (HITS) were 20.3 times more frequent in the CABG-CPB than in the OPCAB group (95% CI, 9.1 to 45; PϽ0.0001). Protein S100 levels were higher in the CABG-CPB than in the OPCAB group 1 hour after surgery (PϽ0.001). HITS were 14.7 times more frequent (95% CI, 3.5 to 62; Pϭ0.001) and S100 level 2.1 times higher (95% CI, 1.3 to 3.5; Pϭ0.005) when retinal microvascular damage was present. Conclusions-The

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

“…A total of 6256 potentially relevant citations were identified and screened, of which 5232 originated from MEDLINE; 224 articles were retrieved for detailed evaluation, of which 22 fulfilled eligibility criteria ( Figure 1) (25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

Off-pump Coronary Artery Bypass Does Not Influence Biomarkers of Brain Injury, But Does Exacerbate the Systemic Inflammatory Response

“…Investigators have explored the use of biomarkers for detecting new brain injuries [5]. This work has been complicated by extracerebral sources of these markers as well as limitations in the diagnostic properties of the assays [6].…”

“…Nonetheless, great interest remains in utilizing these markers as a means for both assessing acute injuries, as well as linking processes of care with an intermediate endpoint (i.e. the levels of a biomarker) [5,7,8].…”

“…A review of the literature on the topic sheds light on the inconsistency in the timing of serum draws and management of extracerebral sources of S100β [6]. For instance, Ascione et al [5] found S100β levels to be 2.4 (CI 95% 1.8 -3.2) times higher among patients undergoing CCAB relative to OPCAB. Ascione attributed these elevations in the CCAB arm to microemboli, as detected through transcranial Doppler.…”

Biomarkers of cerebral injury in cardiac surgery

“…The cerebral biomarkers were firstly reported to assess neurological disorders that were associated with cardiac surgery in 1992. Since then, continuous reports described on these biomarkers in different cardiac operations, in particular, in comparison between on-pump and off-pump in recent years (9,10). However, controversies remain on which factors associated with cardiac surgery may lead to increased biomarkers of cerebral injury, and therefore necessitates a meta-analysis on the relevant aspects.…”