Cerebral embolization during cardiac surgery

Impact of aortic atheroma burden

G. B. Mackensen, L. K. Ti, B. G. Phillips-Bute, J. P. Mathew, M. F. Newman, H. P. Grocott, J. A. Blumenthal, S. E. Hill, J. G. Reves, D. A. Schwinn, M. Stafford-Smith, D. Warner, M. Harris, J. L. Kirchner, B. Mickley, M. Barnes, E. Carver, B. L. Funk, E. D. Derilus, J. Hawkins & 37 others T. Moore, C. Campbell, A. Cheek, T. Kagarise, T. Latiker, E. Lauff, M. Tirronen, R. DeLacy, W. Hansley, Y. M. Connelly, W. D. White, M. A. Babyak, K. A. Welsh-Bohmer, D. B. Mark, M. H. Sketch, C. Graffagnino, D. T. Laskowitz, J. R. Lynch, A. M. Saunders, W. J. Strittmatter, E. Bennett, G. Smigla, I. Shearer, R. W. Anderson, T. A. D'Amico, R. D. Davis, D. D. Glower, R. D. Harpole, J. Jaggers, R. H. Jones, K. Landolfo, J. E. Lowe, R. H. Messier, C. Milano, P. K. Smith, E. M. Toloza, W. G. Wolfe

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)656-661
Number of pages6
JournalBritish Journal of Anaesthesia
Volume91
Issue number5
DOIs
StatePublished - Nov 2003
Externally publishedYes

Fingerprint

Atherosclerotic Plaques
Thoracic Surgery
Thoracic Aorta
Intracranial Embolism
Aorta
Aortic Diseases
Embolism
Middle Cerebral Artery
Cardiopulmonary Bypass
Linear Models
Stroke
Transplants

Keywords

  • Brain, embolism
  • Complications, atherosclerosis
  • Heart, cardiopulmonary bypass
  • Measurement techniques, transcranial Doppler
  • Measurement techniques, transoesophageal echocardiography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Mackensen, G. B., Ti, L. K., Phillips-Bute, B. G., Mathew, J. P., Newman, M. F., Grocott, H. P., ... Wolfe, W. G. (2003). Cerebral embolization during cardiac surgery: Impact of aortic atheroma burden. British Journal of Anaesthesia, 91(5), 656-661. https://doi.org/10.1093/bja/aeg234

Cerebral embolization during cardiac surgery : Impact of aortic atheroma burden. / Mackensen, G. B.; Ti, L. K.; Phillips-Bute, B. G.; Mathew, J. P.; Newman, M. F.; Grocott, H. P.; Blumenthal, J. A.; Hill, S. E.; Reves, J. G.; Schwinn, D. A.; Stafford-Smith, M.; Warner, D.; Harris, M.; Kirchner, J. L.; Mickley, B.; Barnes, M.; Carver, E.; Funk, B. L.; Derilus, E. D.; Hawkins, J.; Moore, T.; Campbell, C.; Cheek, A.; Kagarise, T.; Latiker, T.; Lauff, E.; Tirronen, M.; DeLacy, R.; Hansley, W.; Connelly, Y. M.; White, W. D.; Babyak, M. A.; Welsh-Bohmer, K. A.; Mark, D. B.; Sketch, M. H.; Graffagnino, C.; Laskowitz, D. T.; Lynch, J. R.; Saunders, A. M.; Strittmatter, W. J.; Bennett, E.; Smigla, G.; Shearer, I.; Anderson, R. W.; D'Amico, T. A.; Davis, R. D.; Glower, D. D.; Harpole, R. D.; Jaggers, J.; Jones, R. H.; Landolfo, K.; Lowe, J. E.; Messier, R. H.; Milano, C.; Smith, P. K.; Toloza, E. M.; Wolfe, W. G.

In: British Journal of Anaesthesia, Vol. 91, No. 5, 11.2003, p. 656-661.

Research output: Contribution to journalArticle

Mackensen, GB, Ti, LK, Phillips-Bute, BG, Mathew, JP, Newman, MF, Grocott, HP, Blumenthal, JA, Hill, SE, Reves, JG, Schwinn, DA, Stafford-Smith, M, Warner, D, Harris, M, Kirchner, JL, Mickley, B, Barnes, M, Carver, E, Funk, BL, Derilus, ED, Hawkins, J, Moore, T, Campbell, C, Cheek, A, Kagarise, T, Latiker, T, Lauff, E, Tirronen, M, DeLacy, R, Hansley, W, Connelly, YM, White, WD, Babyak, MA, Welsh-Bohmer, KA, Mark, DB, Sketch, MH, Graffagnino, C, Laskowitz, DT, Lynch, JR, Saunders, AM, Strittmatter, WJ, Bennett, E, Smigla, G, Shearer, I, Anderson, RW, D'Amico, TA, Davis, RD, Glower, DD, Harpole, RD, Jaggers, J, Jones, RH, Landolfo, K, Lowe, JE, Messier, RH, Milano, C, Smith, PK, Toloza, EM & Wolfe, WG 2003, 'Cerebral embolization during cardiac surgery: Impact of aortic atheroma burden', British Journal of Anaesthesia, vol. 91, no. 5, pp. 656-661. https://doi.org/10.1093/bja/aeg234
Mackensen GB, Ti LK, Phillips-Bute BG, Mathew JP, Newman MF, Grocott HP et al. Cerebral embolization during cardiac surgery: Impact of aortic atheroma burden. British Journal of Anaesthesia. 2003 Nov;91(5):656-661. https://doi.org/10.1093/bja/aeg234
Mackensen, G. B. ; Ti, L. K. ; Phillips-Bute, B. G. ; Mathew, J. P. ; Newman, M. F. ; Grocott, H. P. ; Blumenthal, J. A. ; Hill, S. E. ; Reves, J. G. ; Schwinn, D. A. ; Stafford-Smith, M. ; Warner, D. ; Harris, M. ; Kirchner, J. L. ; Mickley, B. ; Barnes, M. ; Carver, E. ; Funk, B. L. ; Derilus, E. D. ; Hawkins, J. ; Moore, T. ; Campbell, C. ; Cheek, A. ; Kagarise, T. ; Latiker, T. ; Lauff, E. ; Tirronen, M. ; DeLacy, R. ; Hansley, W. ; Connelly, Y. M. ; White, W. D. ; Babyak, M. A. ; Welsh-Bohmer, K. A. ; Mark, D. B. ; Sketch, M. H. ; Graffagnino, C. ; Laskowitz, D. T. ; Lynch, J. R. ; Saunders, A. M. ; Strittmatter, W. J. ; Bennett, E. ; Smigla, G. ; Shearer, I. ; Anderson, R. W. ; D'Amico, T. A. ; Davis, R. D. ; Glower, D. D. ; Harpole, R. D. ; Jaggers, J. ; Jones, R. H. ; Landolfo, K. ; Lowe, J. E. ; Messier, R. H. ; Milano, C. ; Smith, P. K. ; Toloza, E. M. ; Wolfe, W. G. / Cerebral embolization during cardiac surgery : Impact of aortic atheroma burden. In: British Journal of Anaesthesia. 2003 ; Vol. 91, No. 5. pp. 656-661.
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abstract = "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.",
keywords = "Brain, embolism, Complications, atherosclerosis, Heart, cardiopulmonary bypass, Measurement techniques, transcranial Doppler, Measurement techniques, transoesophageal echocardiography",
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TY - JOUR

T1 - Cerebral embolization during cardiac surgery

T2 - Impact of aortic atheroma burden

AU - Mackensen, G. B.

AU - Ti, L. K.

AU - Phillips-Bute, B. G.

AU - Mathew, J. P.

AU - Newman, M. F.

AU - Grocott, H. P.

AU - Blumenthal, J. A.

AU - Hill, S. E.

AU - Reves, J. G.

AU - Schwinn, D. A.

AU - Stafford-Smith, M.

AU - Warner, D.

AU - Harris, M.

AU - Kirchner, J. L.

AU - Mickley, B.

AU - Barnes, M.

AU - Carver, E.

AU - Funk, B. L.

AU - Derilus, E. D.

AU - Hawkins, J.

AU - Moore, T.

AU - Campbell, C.

AU - Cheek, A.

AU - Kagarise, T.

AU - Latiker, T.

AU - Lauff, E.

AU - Tirronen, M.

AU - DeLacy, R.

AU - Hansley, W.

AU - Connelly, Y. M.

AU - White, W. D.

AU - Babyak, M. A.

AU - Welsh-Bohmer, K. A.

AU - Mark, D. B.

AU - Sketch, M. H.

AU - Graffagnino, C.

AU - Laskowitz, D. T.

AU - Lynch, J. R.

AU - Saunders, A. M.

AU - Strittmatter, W. J.

AU - Bennett, E.

AU - Smigla, G.

AU - Shearer, I.

AU - Anderson, R. W.

AU - D'Amico, T. A.

AU - Davis, R. D.

AU - Glower, D. D.

AU - Harpole, R. D.

AU - Jaggers, J.

AU - Jones, R. H.

AU - Landolfo, K.

AU - Lowe, J. E.

AU - Messier, R. H.

AU - Milano, C.

AU - Smith, P. K.

AU - Toloza, E. M.

AU - Wolfe, W. G.

PY - 2003/11

Y1 - 2003/11

N2 - 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.

AB - 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.

KW - Brain, embolism

KW - Complications, atherosclerosis

KW - Heart, cardiopulmonary bypass

KW - Measurement techniques, transcranial Doppler

KW - Measurement techniques, transoesophageal echocardiography

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U2 - 10.1093/bja/aeg234

DO - 10.1093/bja/aeg234

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JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

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