Cerebral microemboli during coronary artery bypass using different cardioplegia techniques

Abstract

Larger numbers of microemboli detected by transcranial Doppler echocardiography have been linked to adverse neuropsychological outcome after coronary artery bypass grafting. Differences in neurologic outcome have been attributed to different cardioplegia techniques. Transcranial Doppler-detected microembolic events were recorded during coronary artery bypass grafting using different cardioplegia techniques. Patients received cold antegrade (n = 20), warm antegrade (n = 17), or warm retrograde (n = 20) cardioplegia. Continuous monitoring was divided into stages: aortic cannulation, initiation of cardiopulmonary bypass, aortic cross-clamping, aortic declamping and decannulation until chest closure. Rate of embolic events and number of total and immediate embolic events were tabulated. Total embolic events ranged from 22 to 2,072 per patient and were similar among groups. The rate and total at each stage were similar. Total embolic events were highest during aortic clamping; the rate was highest at initiation of bypass. The immediate embolic events were higher in the warm retrograde group than both antegrade groups at aortic declamping. In summary, a high total and rate of embolic events were detected and differences between cardioplegia techniques were detected.