| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 61-69, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CI Blauth, PL Smith, JV Arnold, JR Jagoe, R Wootton and KM Taylor
We have previously reported the occurrence of microembolic ischemia in the
retina during cardiopulmonary bypass, as revealed by fluorescein
angiography. This method has been extended by digital image analysis to
include quantification of the extent of retinal ischemia and has been
applied to a prospective comparative study of 64 patients undergoing
elective coronary operations with either a bubble or a membrane oxygenator.
Patients with diabetes or clinically evident cerebrovascular disease were
excluded. Bypass procedures were standardized in all cases with pulsatile
flow and a 40 microns arterial line filter (Pall EC Plus). Thirty patients
had bypass with a bubble oxygenator (Harvey H1700) and 34 patients had
bypass with a flat sheet membrane oxygenator (COBE CML). In each case
retinal fluorescein angiograms were obtained preoperatively and 5 minutes
before the end of bypass and were processed with a digital image analyzer
(Context Vision GOP-302). Microembolic perfusion defects were identified by
digital subtraction of preoperative and end-bypass angiograms and their
total area was computed. Results. In the bubble oxygenator group retinal
perfusion defects indicative of microembolism occurred in all 30 (100%)
patients. In contrast, over half the patients in the membrane oxygenator
group had normal retinal perfusion, and the prevalence of perfusion defects
(44%; 70% confidence limits 34% to 54%) was significantly less than in the
bubble group (p less than 0.001). In addition, those patients in the
membrane group had significantly fewer lesions (median 0; 70% confidence
limits 0 to 1) than patients in the bubble group (median 2; 70% confidence
limits 2 to 2; p less than 0.001) and also had significantly smaller total
areas of retinal ischemia (median 0 mm2; 70% confidence limits 0 to 0.16
mm2) than the bubble group (median 0.22 mm2; 70% confidence limits 0.21 to
0.27 mm2; p less than 0.001). There was no relationship between the extent
of retinal ischemia and bypass time, arterial blood gas concentrations,
volume of cardiotomy suction or donor blood returned to the pump, or recent
medication with aspirin. Inferences. Digital image analysis of retinal
fluorescein angiograms may provide a method of quantifying microembolic
ischemia in the central nervous system during cardiopulmonary bypass. Flat
sheet membrane oxygenation appears to provide significantly better
protection against microembolic ischemia than bubble oxygenation.
ARTICLES
Influence of oxygenator type on the prevalence and extent of microembolic retinal ischemia during cardiopulmonary bypass. Assessment by digital image analysis
Department of Surgery, RPMS, Hammersmith Hospital, London, England.
This article has been cited by other articles:
|
|
 |
|
  M. Boodhwani, H. J. Nathan, T. G. Mesana, F. D. Rubens, and Cardiotomy Investigators Effects of Shed Mediastinal Blood on Cardiovascular and Pulmonary Function: A Randomized, Double-Blind Study Ann. Thorac. Surg., October 1, 2008; 86(4): 1167 - 1173. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Hammon Extracorporeal Circulation: Perfusion System Card. Surg. Adult, January 1, 2008; 3(2008): 350 - 370. [Full Text]
|
|
|
|
 |
|
 M Buyukates, S Kargi, O Kandemir, E Aktunc, S. Turan, and A Atalay The use of the retinal nerve fiber layer thickness measurement in determining the effects of cardiopulmonary bypass procedures on the optic nerve Perfusion, November 1, 2007; 22(6): 401 - 406. [Abstract] [PDF]
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Goritz, H. Schelkle, J.-G. Rein, and S. Urbanek Dynamic bubble trap can replace an arterial filter during cardiopulmonary bypass surgery Perfusion, November 1, 2006; 21(6): 367 - 371. [Abstract] [PDF]
|
|
|
|
|
|
J. M Murkin Pathophysiological Basis of CNS Injury in Cardiac Surgical Patients: Detection and Prevention Perfusion, July 1, 2006; 21(4): 203 - 208. [Abstract] [PDF]
|
|
|
|
 |
|
 G. N. Djaiani Aortic arch atheroma: stroke reduction in cardiac surgical patients. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 143 - 157. [Abstract] [PDF]
|
|
|
|
|
|
S. D. Kalyani, N. R. Miller, L. M. Dong, W. A. Baumgartner, D. E. Alejo, and T. B. Gilbert Incidence of and risk factors for perioperative optic neuropathy after cardiac surgery Ann. Thorac. Surg., July 1, 2004; 78(1): 34 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Kaza, J. T. Cope, S. M. Fiser, S. M. Long, J. A. Kern, I. L. Kron, and C. G. Tribble Elimination of fat microemboli during cardiopulmonary bypass Ann. Thorac. Surg., February 1, 2003; 75(2): 555 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Hessel II and L. H. Edmunds Jr. Extracorporeal Circulation: Perfusion Systems Card. Surg. Adult, January 1, 2003; 2(2003): 317 - 338. [Full Text]
|
|
|
|
 |
|
 N. Stroobant, G. Van Nooten, Y. V. Belleghem, and G. Vingerhoets Short-term and long-term neurocognitive outcome in on-pump versus off-pump CABG Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 559 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Murkin, W. D. Boyd, S. Ganapathy, S. J. Adams, R. C. Peterson, J. Morgan, and P. Lok Neuroprotection During CPB: From Mechanisms to Interventions Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2002; 6(1): 3 - 6. [Abstract] [PDF]
|
|
|
|
|
|
W. Plochl, C. G. Krenn, D. J. Cook, E. Gollob, T. Pezawas, H. Schima, O. Ipsiroglu, G. Wollenek, and G. Grubhofer Can hypocapnia reduce cerebral embolization during cardiopulmonary bypass? Ann. Thorac. Surg., September 1, 2001; 72(3): 845 - 849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. H. Kincaid, T. J. Jones, D. A. Stump, W. R. Brown, D. M. Moody, D. D. Deal, and J. W. Hammon Jr Processing scavenged blood with a cell saver reduces cerebral lipid microembolization Ann. Thorac. Surg., October 1, 2000; 70(4): 1296 - 1300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Taggart, S. M. Browne, P. W. Halligan, and D. T. Wade IS CARDIOPULMONARY BYPASS STILL THE CAUSE OF COGNITIVE DYSFUNCTION AFTER CARDIAC OPERATIONS? J. Thorac. Cardiovasc. Surg., September 1, 1999; 118(3): 414 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Soga, H. Fujita, T. Andoh, and F. Okumura Retinal Artery Air Embolism in Dogs: Fluorescein Angiographic Evaluation of Effects of Hypotension and Hemodilution Anesth. Analg., May 1, 1999; 88(5): 1004 - 1010. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Murkin Strategies and Techniques for Neuroprotection in Coronary Artery Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 4 - 8. [Abstract] [PDF]
|
|
|
|
 |
|
 J.E. Arrowsmith, M.J.G. Harrison, S.P. Newman, J. Stygall, N. Timberlake, and W.B. Pugsley Neuroprotection of the Brain During Cardiopulmonary Bypass : A Randomized Trial of Remacemide During Coronary Artery Bypass in 171 Patients Stroke, November 1, 1998; 29(11): 2357 - 2362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. I. Herren, K. S. Kunzelman, C. Vocelka, R.P. Cochran, B. D. Spiess, and F. M. Faraci Angiographic and Histological Evaluation of Porcine Retinal Vascular Damage and Protection With Perfluorocarbons After Massive Air Embolism • Editorial Comment Stroke, November 1, 1998; 29(11): 2396 - 2403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Miyano, M. Inagaki, N. Hashimoto, T. Shishido, T. Kawada, Y. Miyake, and K. Sunagawa Regional cerebral blood flow during rewarming of cardiopulmonary bypass correlates with posthypothermic regional glucose use J. Thorac. Cardiovasc. Surg., September 1, 1998; 116(3): 503 - 507. [Abstract] [Full Text]
|
|
|
|
|
|
L. C. Wagerle, P. Russo, N. S. Dahdah, N. Kapadia, and D. A. Davis Endothelial dysfunction in cerebral microcirculation duringhypothermic cardiopulmonary bypass in newborn lambs J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1047 - 1051. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M Murkin and R. A Jonas Neuropsychometric Testing After Cardiac Surgery: Some Caveats Asian Cardiovasc Thorac Ann, March 1, 1998; 6(1): 79 - 80. [Full Text] [PDF]
|
|
|
|
|
|
A. Undar, C. M. Helfrich, S. B. Johnson, and J. H. Calhoon Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: A prospective, randomized trial J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 482 - 483. [Full Text]
|
|
|
|
|
|
G. Plourde, A. S. Leduc, J. E. Morin, B. DeVarennes, D. Latter, J. Symes, R. Robbins, N. Fosset, L. Couture, and A. Ptito TEMPERATURE DURING CARDIOPULMONARY BYPASS FOR CORONARY ARTERY OPERATIONS DOES NOT INFLUENCE POSTOPERATIVE COGNITIVE FUNCTION: A PROSPECTIVE, RANDOMIZED TRIAL J. Thorac. Cardiovasc. Surg., July 1, 1997; 114(1): 123 - 128. [Abstract] [Full Text]
|
|
|
|
|
|
J. M. Murkin, J. S. Martzke, A. M. Buchan, C. Bentley, and C. J. Wong A RANDOMIZED STUDY OF THE INFLUENCE OF PERFUSION TECHNIQUE AND pH MANAGEMENT STRATEGY IN 316 PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY:II. Neurologic and cognitive outcomes J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 349 - 362. [Abstract] [Full Text]
|
|
|
|
|
|
S. A. Mills Risk Factors for Cerebral Injury and Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1296 - 1299. [Abstract] [Full Text]
|
|
|
|
|
|
C. I. Blauth Macroemboli and Microemboli During Cardiopulmonary Bypass Ann. Thorac. Surg., May 1, 1995; 59(5): 1300 - 1303. [Abstract] [Full Text]
|
|
|
|
|
|
P. L. C. Smith Cerebral Dysfunction After Cardiac Surgery: Closing Address Ann. Thorac. Surg., May 1, 1995; 59(5): 1359 - 1362. [Full Text]
|
|
|
|
|
|
W. R Brown, D. M Moody, S. A Mills, and R. L Anderson Surrogate tissues for detecting brain microemboli after cardiopulmonary bypass Perfusion, November 1, 1994; 9(6): 389 - 392. [Abstract] [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 |
