Neurological Complications after Cardiopulmonary Bypass: An Update

1999 ◽  
Vol 41 (3) ◽  
pp. 128-134 ◽  
Author(s):  
Y. Carrascal ◽  
A.L. Guerrero ◽  
L.C. Maroto ◽  
J.M. Cortina ◽  
J.E. Rodríguez ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Neurological Complications

scholarly journals Neural network-based modeling of the number of microbubbles generated with four circulation factors in cardiopulmonary bypass

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Satoshi Miyamoto ◽  
Zu Soh ◽  
Shigeyuki Okahara ◽  
Akira Furui ◽  
Taiichi Takasaki ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Flow Rate ◽  
Neurological Complications ◽  
Estimation Accuracy ◽  
Model Parameters ◽  
Perfusion Flow ◽  
Postsurgical Complication ◽  
Tenfold Cross Validation ◽  
Suction Flow ◽  
The Relationship

AbstractThe need for the estimation of the number of microbubbles (MBs) in cardiopulmonary bypass surgery has been recognized among surgeons to avoid postoperative neurological complications. MBs that exceed the diameter of human capillaries may cause endothelial disruption as well as microvascular obstructions that block posterior capillary blood flow. In this paper, we analyzed the relationship between the number of microbubbles generated and four circulation factors, i.e., intraoperative suction flow rate, venous reservoir level, continuous blood viscosity and perfusion flow rate in cardiopulmonary bypass, and proposed a neural-networked model to estimate the number of microbubbles with the factors. Model parameters were determined in a machine-learning manner using experimental data with bovine blood as the perfusate. The estimation accuracy of the model, assessed by tenfold cross-validation, demonstrated that the number of MBs can be estimated with a determinant coefficient R2 = 0.9328 (p < 0.001). A significant increase in the residual error was found when each of four factors was excluded from the contributory variables. The study demonstrated the importance of four circulation factors in the prediction of the number of MBs and its capacity to eliminate potential postsurgical complication risks.

Early Neurological Complications after Cardiac/Aortic Surgery with Cardiopulmonary Bypass: Incidence and Risk Factors

2021 ◽  
Vol 104 (7) ◽  
pp. 1060-1066
Keyword(s):  
Cardiopulmonary Bypass ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Artery Bypass ◽  
Aortic Surgery ◽  
Neurological Complications ◽  
Serum Lactate ◽  
Valve Surgery ◽  
History Of ◽  
Bypass Technique

Objective: To examine the incidence and risk factors of early neurological complications after cardiac or aortic surgery using cardiopulmonary bypass technique in King Chulalongkorn Memorial Hospital, Thailand. Materials and Methods: The present study was a retrospective cohort study. Clinical data of adult patients that underwent cardiac or aortic surgery using cardiopulmonary bypass technique in 2018 were reviewed from the electronic medical record in the authors’ center. Results: Early postoperative neurological complications occurred in 33 (8.3%) of the 400 patients. Twenty of them (60.6%) had non-specific encephalopathy, three (9.1%) had hypoxic-ischemic encephalopathy, five (15.2%) had provoked seizure, four (12.1%) had cerebral infarction, and one (3.0%) had intracranial hemorrhage. Associated clinical factors included history of essential hypertension [adjusted odds ratio 3.448 (95% CI 1.266 to 9.391)], combined coronary artery bypass grafting and valve surgery [adjusted odds ratio 4.759 (95% CI 1.182 to 19.170)], multi-valve surgery [adjusted odds ratio 5.201 (95% CI 1.227 to 22.049)], aortic surgery [adjusted odds ratio 17.260 (95% CI 4.168 to 71.468)], higher midazolam dosage [adjusted odds ratio 1.009 (95% CI 1.002 to 1.015)], higher serum lactate prior to discontinuing cardiopulmonary bypass [adjusted odds ratio 1.263 (95% CI 1.093 to 1.460)], and presence of intraoperative intra-aortic balloon pump use [adjusted odds ratio 6.160 (95% CI 1.883 to 20.150)]. Conclusion: Early postoperative neurological complications rate of cardiac or aortic surgery using cardiopulmonary bypass technique in the present study settings was 8.3%. Preoperative and intraoperative clinical factors associated with such complications were the history of essential hypertension, the type of surgery such as combined coronary artery bypass grafting and valve surgery, multi-valve surgery, and aortic surgery, the higher midazolam dosage, the higher serum lactate prior to discontinuing cardiopulmonary bypass, and the presence of intraoperative intra-aortic balloon pump use. Keywords: Cardiac surgery; Aortic surgery; Cardiopulmonary bypass; Postoperative neurological complications; Encephalopath

scholarly journals Management of infective endocarditis in patients with post-stroke brain damages

2019 ◽  
pp. 84-96
Author(s):  
V. V. Fedko ◽  
S. P. Spysarenko ◽  
T. O. Malysheva ◽  
D. V. Pochynock
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Ischemic Stroke ◽  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Neurological Impairment ◽  
Neurological Complications ◽  
Cerebrovascular Complications ◽  
Management Protocol

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis. The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved. Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation. Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment. The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications. In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

scholarly journals Aprotinin concentration varies significantly according to cardiopulmonary bypass conditions

Perfusion ◽  
2008 ◽  
Vol 23 (6) ◽  
pp. 355-360
Author(s):  
T Okamura ◽  
N Ishibashi ◽  
Y Iwata ◽  
D Zurakowski ◽  
RA Jonas
Keyword(s):  
Cardiopulmonary Bypass ◽  
Initial Dose ◽  
Circulatory Arrest ◽  
Neurological Complications ◽  
Low Flow ◽  
Control Group ◽  
Maintenance Infusion ◽  
Minute Period ◽  
Reperfusion Period ◽  
Modified Functional

Although aprotinin is partially excreted unchanged in the urine, its primary site of metabolism is in the renal lysosomes following proximal tubule resorption. This study tested the hypothesis that plasma aprotinin concentration varies with cardiopulmonary bypass conditions. Thirty-two piglets (weight 13.2 ± 1.9 kg) received an aprotinin initial dose of 30,000 KIU/kg, a maintenance infusion of 10,000 KIU/kg/h, with a cardiopulmonary bypass (CPB) prime of 30,000 KIU/kg. Aprotinin infusion was terminated at the end of CPB and stopped during hypothermic circulatory arrest (HCA). Piglets were randomized to four groups (n = 8 per group): HCA, 60-minute period at 15°C; low-flow (LF), 10 mL/kg/min low-flow CPB at 25°C; full flow (FF), full flow CPB at 37°C; control at 37°C without CPB. Blood samples were collected at 7 time points: after induction of anesthesia (baseline), after initial dose, 10, 50 and 115 min after start of CPB, just before end of CPB and 30 min after CPB. Plasma aprotinin levels were determined by modified functional assays. Aprotinin levels in the control group were significantly lower at each point after start of CPB than all groups with CPB ( p < .001). In particular, during the reperfusion period, aprotinin levels were higher in HCA and LF groups than FF group ( p < .05). Throughout CPB, aprotinin levels in the HCA group remained unchanged ( p > .40). Bypass conditions affect plasma aprotinin concentration. Recently reported renal and neurological complications with aprotinin use during CPB may reflect excessive dosing and point to the need for real-time monitoring.

scholarly journals Optimizing cerebral perfusion and hemodynamics during cardiopulmonary bypass through cannula design combining in silico, in vitro and in vivo input

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kristin Hugenroth ◽  
Ralf Borchardt ◽  
Philine Ritter ◽  
Sascha Groß-Hardt ◽  
Bart Meyns ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
In Silico ◽  
Cerebral Perfusion ◽  
Standard Technique ◽  
Neurological Complications ◽  
Shear Stresses ◽  
Cfd Simulations ◽  
Increased Risk

AbstractCardiopulmonary bypass (CPB) is a standard technique for cardiac surgery, but comes with the risk of severe neurological complications (e.g. stroke) caused by embolisms and/or reduced cerebral perfusion. We report on an aortic cannula prototype design (optiCAN) with helical outflow and jet-splitting dispersion tip that could reduce the risk of embolic events and restores cerebral perfusion to 97.5% of physiological flow during CPB in vivo, whereas a commercial curved-tip cannula yields 74.6%. In further in vitro comparison, pressure loss and hemolysis parameters of optiCAN remain unaffected. Results are reproducibly confirmed in silico for an exemplary human aortic anatomy via computational fluid dynamics (CFD) simulations. Based on CFD simulations, we firstly show that optiCAN design improves aortic root washout, which reduces the risk of thromboembolism. Secondly, we identify regions of the aortic intima with increased risk of plaque release by correlating areas of enhanced plaque growth and high wall shear stresses (WSS). From this we propose another easy-to-manufacture cannula design (opti2CAN) that decreases areas burdened by high WSS, while preserving physiological cerebral flow and favorable hemodynamics. With this novel cannula design, we propose a cannulation option to reduce neurological complications and the prevalence of stroke in high-risk patients after CPB.

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