JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Christof Schmid
Hans H. Scheld
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Thoennissen, N. H.
Right arrow Articles by Nabavi, D. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Thoennissen, N. H.
Right arrow Articles by Nabavi, D. G.

J Thorac Cardiovasc Surg 2005;130:1159-1166
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

High level of cerebral microembolization in patients supported with the DeBakey left ventricular assist device

Nils H. Thoennissen, MD a , Michael Schneider, MD b , Achim Allroggen, MD a , Martin Ritter, MD a , Ralf Dittrich, MD a , Christof Schmid, MD b , Hans H. Scheld, MD b , E. Bernd Ringelstein, MD a , Darius G. Nabavi, MD a , *

a Department of Neurology, University of Münster, Münster, Germany
b Department of Thoracic and Cardiovascular Surgery, University of Münster, Münster, Germany

Received for publication July 20, 2004; revisions received February 16, 2005; accepted for publication February 22, 2005.

* Address for reprints: Darius G. Nabavi, MD, Department of Neurology, University of Münster, Albert Schweitzer-Str 33, 48129 Münster, Germany (Email: nabavi{at}uni-muenster.de).

OBJECTIVE: Microembolic signals detected by transcranial Doppler ultrasonography have been demonstrated to be clinically relevant in patients supported with pulsatile left ventricular assist devices. We prospectively investigated the quantity of microembolic signals in patients supported with the continuous-flow DeBakey left ventricular assist device (MicroMed DeBakey VAD; MicroMed Technology, Inc, Houston, Tex) including the refined Carmeda BioActive Surface system (Carmeda AB, Stockholm, Sweden).

METHODS: Twenty-three patients (20 male) aged 14 to 62 years supported with DeBakey left ventricular assist devices (n = 6 with Carmeda) were enrolled in this study. Microembolic signal monitorings were performed twice weekly by insonating the middle cerebral artery for 20 minutes without and 20 minutes with oronasal application of oxygen (6 L/min). Evidence of clinically manifest thromboembolic events was based on regular questionnaires, clinical examinations, and results of diagnostic procedures.

RESULTS: Despite a low incidence of thromboembolic complications (0.24 per 100 left ventricular assist device days), 20 patients (87%) showed circulating microemboli. Overall, microembolic signals were found in 175 of 499 transcranial Doppler ultrasonographic examinations (35.1%), with mean counts of 81.2 ± 443 (range 0-5042 signals/h). Both microembolic signal prevalence (25% vs 34%, P = .01) and absolute signal counts (46.5 vs 104, P < .01) significantly declined with oxygen delivery. There was no significant correlation between the individual microembolic signal activity and the incidence of clinical thromboembolism or the intensity of antihemostatic treatment. Patients supported with the Carmeda device did not show reduced rates of clinical thromboembolization or cerebral microemboli.

CONCLUSION: In patients with DeBakey left ventricular assist devices, a high load of clinically silent microemboli can be detected within the cerebral arteries despite a low incidence of embolic complications. It needs to be investigated whether such continuous, presumably gaseous microembolization causes cognitive or neuropsychologic deficits.

18; 27; 34




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. John, F. Kamdar, K. Liao, M. Colvin-Adams, L. Miller, L. Joyce, and A. Boyle
Low thromboembolic risk for patients with the Heartmate II left ventricular assist device.
J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1318 - 1323.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. John, F. Kamdar, K. Liao, M. Colvin-Adams, A. Boyle, and L. Joyce
Improved Survival and Decreasing Incidence of Adverse Events With the HeartMate II Left Ventricular Assist Device as Bridge-to-Transplant Therapy
Ann. Thorac. Surg., October 1, 2008; 86(4): 1227 - 1235.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
R. Dittrich and E. B. Ringelstein
Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures
Stroke, February 1, 2008; 39(2): 503 - 511.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2005 by The American Association for Thoracic Surgery.