Seminars in Thoracic and Cardiovascular Surgery
Volume 13, Issue 2 , Pages 184-191 , April 2001

Approaches to reduce neurologic complications during cardiac surgery

References 

  1. Harrison MJG, Schneidau A, Ho R, et al.  Cerebrovascular disease and functional outcome after coronary artery bypass surgery. Stoke. 1989;20:235–237
  2. Stump DA. Selection and clinical significance of neuropsychological tests. Ann Thorac Surg. 1995;59:1340–1344
  3. Stump DA, Brown WR, Moody DM, et al.  Microemboli and neurologic dysfunction after cardiovascular surgery. Semin Cardiothorac Vasc Anesth. 1999;3:47–54
  4. Stump DA, Rogers AT, Hammon JW. Neurobehavioral tests are monitoring tools used to improve cardiac surgery outcome. Ann Thorac Surg. 1996;61:1295–1296
  5. Stump DA, Rogers AT, Hammon JW, et al.  Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothoracic Anesth. 1996;10:1–8
  6. Redmond JM, Greene PS, Goldsborough MA, et al.  Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996;61:42–47
  7. Tardiff BE, Newman MF, Saunders AM, et al.  Preliminary report of a genetic basis for cognitive decline after cardiac operations. Ann Thorac Surg. 1997;64:715–720
  8. Gott JP, Cooper WA, Schmidt FE, et al.  Modifying risk for extracorporeal circulation. Trial of four antiinflammatory strategies. Ann Thorac Surg. 1998;66:747–754
  9. Blauth CL, Cosgrove DM, Webb BW. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg. 1992;103:1104–1112
  10. Goto T, Baba T, Yoshitake A, et al.  Craniocervical and aortic atherosclerosis as neurologic risk factors in coronary surgery. Ann Thorac Surg. 2000;69:834–840
  11. Wareing TH, Davila-Roman VG, Daily BB, et al.  Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg. 1993;55:1400–1408
  12. Khatibzadeh M, Mitusch R, Stierle U, et al.  Aortic atherosclerotic plaques as a source of systemic embolism. J Am Coll Cardiol. 1996;27:664–669
  13. Slogoff S, Girgis KZ, Keats AS. Etiologic factors in neuropsychiatric complications associated with cardiopulmonary bypass. Anesth Analg. 1982;61:903–911
  14. Neville MU, Butterworth J, James RL, et al.  Similar neurobehavioral outcome after valve or coronary artery operations despite differing carotid embolic counts. J Thorac Cardiovasc Surg. 2001;121:125–136
  15. Moody DM, Bell MA, Challa VR, et al.  Brain microemboli during cardiac surgery or aortography. Ann Neurol. 1990;28:477–486
  16. Moody DM, Brown WF, Challa VR, et al.  Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study. Ann Thorac Surg. 1995;59:1304–1307
  17. Harris DNF, Oatridge A, Dob D, et al.  Cerebral swelling after normothermic cardiopulmonary bypass. Anesthesiology. 1998;88:340–345
  18. Cook DJ, Oliver WC, Orsulak TA, et al.  Cardiopulmonary bypass temperature, hematocrit, and cerebral oxygen delivery in humans. Ann Thorac Surg. 1995;60:1671–1677
  19. Patel RL, Turtle MR, Chambers DJ, et al.  Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1996;111:1267–1279
  20. Jones TJ, Stump DA, Deal D, et al.  Hypothermia protects the brain from embolization by reducing and redirecting the embolic load. Ann Thorac Surg. 1999;68:1465
  21. Michenfelder JD. The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology. 1974;41:231–236
  22. Nussmeier N, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: Cerebral protection by a barbiturate. Anesthesiology. 1986;64:165–170
  23. Arrowsmith JE, Harrison MJG, Newman SP, et al.  Neuroprotection of the brain during cardiopulmonary bypass. A randomized trial of remacemide during coronary artery bypass in 171 patients. Stroke. 1998;29:2357–2362
  24. Boston US, Sungurtekin H, Christopher GA, et al.  Differential perfusion: A new technique for isolated brain cooling during cardiopulmonary bypass. Ann Thorac Surg. 2000;69:1346–1350
  25. Avraamides EJ, Murkin JM. The effect of surgical dislocation of the heart on cerebral blood flow in the presence of a single, two-stage venous cannula during cardiopulmonary bypass. Can J Anaesth. 1996;43:A36
  26. Sylviris S, Calafiore P, Matalanis G, et al.  The intraoperative assessment of ascending aortic atheroma: Epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. J Cardiothorac Vasc Anesth. 1997;11:704–707
  27. Hammon JW, Stump DA, Kon ND, et al.  Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg. 1997;63:1613–1618
  28. Loop FD, Higgins TL, Panda R, et al.  Myocardial protection during cardiac operations: Decreased morbidity and lower cost with blood cardioplegia and coronary sinus perfusion. J Cardiovasc Surg. 1992;104:608–618
  29. Tector AJ, Amundsen S, Schmahl TM, et al.  Total revascularization with T Grafts. Ann Thorac Surg. 1994;57:33–39
  30. Diegeler A, Hirsch R, Schneider F, et al.  Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg. 2000;69:1162–1166
  31. van der LJ, Casimir-Ahn H. When do cerebral emboli appear during open-heart operations? A transcranial Doppler study. Ann Thorac Surg. 1991;51:237–241
  32. Tingleff JJ, Pettersson G. Intraoperative echocardiographic study of air embolism during cardiac operations. Ann Thorac Surg. 1995;60:673–677
  33. Webb WR, Harrison LH, Helmcke FR, et al.  Carbon dioxide field flooding minimizes residual intracardiac air after open heart operations. Ann Thorac Surg. 1997;64:1489–1491
  34. Jones TJ, Deal TD, Vernon W, et al: Propagation of entrained air during cardiopulmonary bypass is affected by circuit design but not by vacuum assisted venous drainage. J Cardiothorac Vasc Anesth (in press)
  35. Brooker RF, Brown WR, Moody DM, et al.  Cardiotomy suction: A major source of brain lipid emboli during cardiopulmonary bypass. Ann Thorac Surg. 1998;65:1651–1655
  36. Kincaid EH, Jones TJ, Stump DA, et al.  Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg. 2000;70:1296–1300

 Supported in part by National Institutes of Health grants from the National Institute of Neurologic Diseases and Stroke: NS 28955, NS 20618, and NS 27500.

☆☆ Address reprint requests to John W. Hammon, MD, Department of Cardiothoracic Surgery, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jhammon@wfubmc.edu

PII: S1043-0679(01)70033-0

Seminars in Thoracic and Cardiovascular Surgery
Volume 13, Issue 2 , Pages 184-191 , April 2001