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J Thorac Cardiovasc Surg 2006;131:268-276
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization

A. Liebold, MD, PhD a , * , A. Khosravi a , B. Westphal, MD a , C. Skrabal, MD a , Y.H. Choi, MD a , C. Stamm, MD a , A. Kaminski, MD a , A. Alms, MD b , T. Birken, MD b , D. Zurakowski, PhD c , G. Steinhoff, MD, PhD a

a Department of Cardiac Surgery, University of Rostock, Rostock, Germany
b Department of Anesthesiology, University of Rostock, Rostock, Germany
c Department of Biostatistics, Children's Hospital, Harvard Medical School Boston, Mass.

Read at the Thirty-first Annual Meeting of The Western Thoracic Surgical Association, Victoria, BC, Canada, June 22-25, 2005.

Received for publication June 14, 2005; revisions received September 2, 2005; accepted for publication September 13, 2005.

* Address for reprints: Prof Dr med Andreas Liebold, Klinik für Herzchirurgie, Medizinische Fakultät, Universität Rostock, Schillingallee 35, 18055 Rostock, Germany. (Email: andreas.liebold{at}med.uni-rostock.de).

OBJECTIVE: Coronary artery bypass grafting with cardiopulmonary bypass carries a risk for neurologic complications because of cerebral hypoperfusion and microembolization. The basic goals of a novel closed minimized extracorporeal circulation are to prevent excessive hemodilution and to avoid blood-air interface. The aim of this prospective randomized study was to determine the effect of using the minimized extracorporeal circulation system compared with open conventional extracorporeal circulation on cerebral tissue oxygenation and microembolization.

METHODS: Forty patients undergoing coronary artery bypass grafting (20 in each group) were continuously monitored for changes in cerebral oxygenated hemoglobin and tissue oxygenation index by using near-infrared spectroscopy. Total microembolic count and gaseous embolic count in both median cerebral arteries were monitored with multifrequency transcranial Doppler instrumentation.

RESULTS: In the conventional extracorporeal circulation group there was a highly significant reduction in both cerebral oxygenated hemoglobin and tissue oxygenation index from the start to the end of cardiopulmonary bypass (P < .01). The rate of decrease in cerebral oxygenated hemoglobin after aortic cannulation was faster in the conventional extracorporeal circulation group (F test = 9.03, P < .001). No significant changes with respect to cerebral oxygenated hemoglobin or tissue oxygenation index occurred in the minimized extracorporeal circulation group, except at the beginning of rewarming (P < .01). Total embolic count, as well as gaseous embolic count, in the left and right median cerebral arteries was significantly lower in the minimized extracorporeal circulation group (all P < .05). Postoperative bleeding was greater (P < .05) and the transfusion rate was higher (P < .05) in the conventional extracorporeal circulation group.

CONCLUSIONS: Use of closed minimized cardiopulmonary bypass compared with conventional open cardiopulmonary bypass preserves cerebral tissue oxygenation and reduces cerebral microembolization.

Abbreviations and Acronyms ANOVA = analysis of variance; CABG = coronary artery bypass grafting; CECC = conventional extracorporeal circulation; CPB = cardiopulmonary bypass; MECC = minimized extracorporeal circulation; MO = membrane oxygenator; NIRS = near-infrared spectroscopy; O2Hb = oxygenated hemoglobin; SaO 2 = arterial oxygen saturation; TCD = transcranial Doppler; TOI = tissue oxygenation index




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