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Ann Thorac Surg 1999;68:1459
© 1999 The Society of Thoracic Surgeons

Supplement: Outcomes ’99: Scientific Abstracts

Cerebral emboli during CABG with differing proximal graft anastomosis techniques

D.C. Adams, MDa,b, E.J. Heyer, PhD, MDa,b, C.R. Smith, MDa,b, M.C. Oz, MDa,b, E.A. Rose, MDa,b, N. Edwards, MDa,b, M.B. Simon, MDa,b

a Mount Sinai School of Medicine and Columbia University, New York, New York, USA
b Columbia University, New York, New York, USA

Background: Cerebral microemboli occur during cardiopulmonary bypass (CPB) particularly during aortic manipulations [1, 2]. We undertook this preliminary study to determine whether differing techniques of proximal graft anastomosis affected embolic rates during coronary artery bypass grafting (CABG).

Methods: Patients undergoing CPB for CABG with proximal grafts performed either with single aortic cross-clamp (SAC, n = 8) or side-biting clamp (SBC, n = 3) consented to this Institutional Review Board approved study. Signals were obtained from the left MCA with a 2 MHz pulsed wave TCD probe (Multigon, Yonkers, NY), recorded on videotape, and reviewed offline. Embolic rates (ER) were calculated and compared for the following intraoperative periods: incision-cannulation (A), cannulation-XC on (B), XC on-XC off (C), XC off-SB on (D), SB on-SB off (E), SB/XC off-off CPB (F), and off CPB-decannulation (G).

Results: The mean overall ERs were not significantly different (SAC = 3.39 ± 1.35; SBC = 4.69 ± 1.01, p > .05), however mean ER was significantly less in the SBC group during period F (2.7 ± 1.2 vs 10.3 ± 5.7, p = 0.003) and the combined periods D, E, and F (4.3 ± 1.7, p = 0.01). Although most emboli occurred during period C, the highest embolic rates tended to occur during period F.

Conclusions: Since SBC patients had less emboli during aortic manipulations than comparable periods in the SAC patients, some other factor, such as the degree of aortic atheroma, may affect cerebral embolic events. In this small study, proximal graft technique does not appear to affect the incidence of cerebral microemboli.

References

  1. Ann Thorac Surg 1997;63:1613–8.
  2. Stroke 1997;28:1988–92.




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