Cerebral embolization during cardiac surgery: impact of aortic atheroma burden.

BACKGROUND Aortic atheromatous disease is known to be associated with an increased risk of perioperative stroke in the setting of cardiac surgery. In this study, we sought to determine the relationship between cerebral microemboli and aortic atheroma burden in patients undergoing cardiac surgery. METHODS Transoesophageal echocardiographic images of the ascending, arch and descending aorta were evaluated in 128 patients to determine the aortic atheroma burden. Transcranial Doppler (TCD) of the right middle cerebral artery was performed in order to measure cerebral embolic load during surgery. Using multivariate linear regression, the numbers of emboli were compared with the atheroma burden. RESULTS After controlling for age, cardiopulmonary bypass time and the number of bypass grafts, cerebral emboli were significantly associated with atheroma in the ascending aorta (R2=0.11, P=0.02) and aortic arch (P=0.013). However, there was no association between emboli and descending aortic atheroma burden (R2=0.05, P=0.20). CONCLUSIONS We demonstrate a positive relationship between TCD-detected cerebral emboli and the atheromatous burden of the ascending aorta and aortic arch. Previously demonstrated associations between TCD-detectable cerebral emboli and adverse cerebral outcome may be related to the presence of significant aortic atheromatous disease.

[1]  D. Reich,et al.  The Ascending Aorta: How Much Does Transesophageal Echocardiography See? , 1994, Anesthesia and analgesia.

[2]  W J Stewart,et al.  ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certifi , 1999, Anesthesia and analgesia.

[3]  G. Hartman,et al.  Aortic atheroma is related to outcome but not numbers of emboli during coronary bypass. , 1997, The Annals of thoracic surgery.

[4]  J. Hammon,et al.  Cerebral emboli and cognitive outcome after cardiac surgery. , 1996, Journal of cardiothoracic and vascular anesthesia.

[5]  D M Reboussin,et al.  Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study. , 1995, The Annals of thoracic surgery.

[6]  T. Treasure,et al.  The Impact of Microemboli During Cardiopulmonary Bypass on Neuropsychological Functioning , 1994, Stroke.

[7]  P. Williams-Russo,et al.  Cerebral Emboli Detected During Bypass Surgery Are Associated With Clamp Removal , 1994, Stroke.

[8]  J. Hammon,et al.  Neurobehavioral tests are monitoring tools used to improve cardiac surgery outcome. , 1996, Annals of Thoracic Surgery.

[9]  M. Newman,et al.  Apolipoprotein E4 increases aortic atheroma burden in cardiac surgical patients. , 2003, The Journal of thoracic and cardiovascular surgery.

[10]  J. Gold,et al.  Comparison of transcranial Doppler ultrasonography and transesophageal echocardiography to monitor emboli during coronary artery bypass surgery. , 1996, Stroke.

[11]  H. Rusinek,et al.  Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. , 1992, Journal of the American College of Cardiology.

[12]  C. Doherty,et al.  Vascular events during follow-up in patients with aortic arch atherosclerosis. , 1997, Stroke.

[13]  M. Kanchuger,et al.  Superiority of transesophageal echocardiography in detecting aortic arch atheromatous disease: identification of patients at increased risk of stroke during cardiac surgery. , 1994, Journal of cardiothoracic and vascular anesthesia.

[14]  G. Berry,et al.  Particulate emboli capture by an intra-aortic filter device during cardiac surgery. , 2000, The Journal of thoracic and cardiovascular surgery.

[15]  N. Kouchoukos,et al.  Strategy for the reduction of stroke incidence in cardiac surgical patients. , 1993, The Annals of thoracic surgery.

[16]  C. Blauth,et al.  RETINAL MICROEMBOLISM DURING CARDIOPULMONARY BYPASS DEMONSTRATED BY FLUORESCEIN ANGIOGRAPHY , 1986, The Lancet.

[17]  F. Loop,et al.  Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. , 1992, The Journal of thoracic and cardiovascular surgery.

[18]  R. Sacco,et al.  Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. , 1996, The New England journal of medicine.

[19]  J. Gold,et al.  Severity of Aortic Atheromatous Disease Diagnosed by Transesophageal Echocardiography Predicts Stroke and Other Outcomes Associated with Coronary Artery Surgery: A Prospective Study , 1996, Anesthesia and analgesia.

[20]  Mark F. Newman,et al.  Adverse Cerebral Outcomes after Coronary Bypass Surgery , 1996 .