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Ann Thorac Surg 2000;70:1796
© 2000 The Society of Thoracic Surgeons

Scientific abstract

Epiaortic scanning significantly decreases cerebral embolic load associated with aortic instrumentation for cardiopulmonary bypass

J.M. Murkin, MD, A. Menkis, MD, D. Downey, MD, W. Nantau, BSc, R. Peterson, MSc, C. Meyer, RN, S. Adams, RN

Departments of Anesthesia and Surgery, University Hospital Campus-LHSC, University of Western Ontario, London, Canada (Supported by funding from MRC grant MT13406)

Introduction. Cerebral emboli are detectable with transcranial Doppler (TCD). Epiaortic Doppler scanning can detect otherwise silent aortic atherosclerotic plaque. We assessed whether epiaortic scanning before aortic instrumentation could decrease cerebral embolic load.

Methods. After obtaining written informed consent, 189 patients undergoing coronary artery bypass surgery were randomized to epiaortic scanning or manual palpation before aortic instrumentation. Bihemispheric TCD signals were recorded at specific intervals: 1) aortic cannulation, 2) on cardiopulmonary bypass (CPB), 3) aortic X-clamp on, 4) aortic X-clamp off, 5) aortic side-clamp on, 6) aortic side-clamp off, 7) aortic decannulation, and 8) total emboli) were compared between groups. For statistical analysis unpaired t test where p < 0.05 was required for significance, was employed.

Results. There was no significant difference between groups regarding age, gender, duration of CPB, or numbers of vessels grafted. Epiaortic scanning was associated with significantly fewer emboli at various times associated with aortic instrumentation and CPB (Fig 1).

Conclusions. Epiaortic scanning significantly decreases cerebral embolic load during aortic instrumentation.




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