Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery.
Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic f...
| Publicado en: | Perfusion Vol. 18; pp. 55 - 61 |
|---|---|
| Autores principales: | , , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Sage Publications, Ltd.
Jan2003 Supplement
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106705611&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106705611 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02676591 31J jtl: Perfusion issn: 02676591 maglogo: N pubinfo: dt: Jan2003 Supplement vid: 18 pid: 33180 pub: Sage Publications, Ltd. place: <Blank> artinfo: ui: 106705611 2004037162 10.1191/0267659103pf628oa NLM12708766 106705611 ppf: 55 ppct: 6 formats: fmt: @attributes: type: P tig: atl: Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery. aug: au: Eifert S Reichenspurner H Pfefferkorn T Baur B von Schlippenbach C Mayer TE Hamann G Reichart B affil: Department of Cardiac Surgery, University Hospital Munich Grosshadern, Germany; Sandra.Eifert@hch.med.uni-muenchen.de sug: subj: Cardiac Surgery Evaluation Cardiac Surgery Methods Cognition Evaluation Coronary Artery Bypass Descriptive Statistics Germany Hemodynamics Evaluation Magnetic Resonance Imaging Microscopy Middle Age Paired T-Tests Treatment Outcomes Evaluation Wilcoxon Rank Sum Test Human Middle Aged: 45-64 years ab: Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic filter device has an effect on the magnet resonance imaging (MRI) and functional neurological outcome. Twenty-four patients undergoing cardiosurgical procedures using cardiopulmonary bypass (CPB) were selected: coronary artery bypass graft (CABG) surgery (n = 17), aortic valve replacement (AVR) surgery (n = 4) or combined procedures (n = 3). Patients were evaluated by diffusion weighted MRI of the brain, neurological examination and neuropsychological assessment regarding alertness as well as divided and selective attention before and five to seven days after surgery. The patients were divided into two groups. In group I, 12 patients received a filter through a modified 24 F arterial cannula immediately before the aortic crossclamp was released. Filters remained in the aorta until CPB was discontinued. Intraoperatively, bilateral middle cerebral artery transcranial Doppler (TCD) was monitored at baseline, at the beginning of CPB, at a timepoint when the aorta was crossclamped, when the filter was inserted and while the crossclamp was switched to partial clamping until the CPB was discontinued. TCD was used for detection of microembolic signals (MES). The captured material in the filter was examined histologically. Twelve patients served as controls without aortic filtration (group II). The MRI of the brain did not show any diffusion alterations in either group before or after surgery. No patient developed a focal neurological deficit or stroke. Intraoperative quantitative MES detection revealed a four to tenfold increase in patients of group I compared with group II (5-6 versus 0.5-1 MES/min) during the filter dwell time. There was no consistent pattern regarding the neurobehavioural sequelae. Filters showed arteriosclerotic debris in 75% of the patients. The use of the intra-aortic filter device did not show a positive effect on neurological, neuroradiographical and neuropsychological outcomes. The increase of the MES rate in group I patients may be due to microbubbles generated as microcavitations by the filter or the aortic filter cannula. The intra-aortic filter was able to capture atheromatous material in 75% of the patients. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|