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Eur J Cardiothorac Surg 2001;20:1163-1167
© 2001 Elsevier Science NL
University Hospital of South Manchester, West Didsbury, Manchester M20 2LR, UK
Received 31 March 2001; received in revised form 21 August 2001; accepted 31 August 2001.
Corresponding author. Tel.: +44-161-291-3840; fax: +44-161-291-3946
e-mail: cnmcc{at}fs1.with.man.ac.uk
Objectives: Cerebral microembolisation still occurs during cardiopulmonary bypass and may cause both stroke and postoperative cognitive impairment. We investigated the frequency of cerebral embolisation during coronary artery bypass surgery with modern cardiopulmonary bypass and related these to ascending aortic atherosclerosis. Methods: Transcranial Doppler monitoring for cerebral embolisation to both middle cerebral arteries was performed in 65 patients undergoing coronary artery surgery with non-pulsatile alpha-stat hypothermic bypass. Epicardial ultrasound imaging of ascending aortic atherosclerosis was performed in 14 patients. Results: Thirty patients (56.9%) had more than 200 emboli entering the middle cerebral artery territories during surgery; most at the start of bypass and during defibrillation. Readjustment of aortic clamps and aortic cannulation also caused a large number of emboli which were probably particulate. Aortic disease was mild (mean plaque thickness 1 mm, interquartile range 0.9–1.2 mm) and did not relate to the number of cerebral emboli produced by aortic manipulation. Conclusions: Cerebral embolisation remains common during coronary surgery despite advances in filter and bypass pump technology. Aortic manipulation and clamping was associated with emboli but epicardial ultrasound imaging was of little help in its prediction.
Key Words: Embolisation • Cardiopulmonary bypass • Epicardial aortic scanning
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