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Role of Transcranial Doppler in Cardiac Surgery Patients. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose of Review
This review discusses applications of transcranial Doppler (TCD) in cardiac surgery, its efficacy in preventing adverse events such as postoperative cognitive decline and stroke, and its impact on clinical outcomes in these patients.
Recent Findings
TCD alone and in combination with other neuromonitoring modalities has attracted attention as a potential monitoring tool in cardiac surgery patients. TCD allows not only the detection of microemboli and measurement of cerebral blood flow velocity in cerebral arteries but also the assessment of cerebral autoregulation.
Summary
Neuromonitoring is critically important in cardiac surgery as surgical and anesthetic interventions as well as several other factors may increase the risk of cerebral embolization (gaseous and particulate) and cerebral perfusion anomalies, which may lead to adverse neurological events. As an experimental tool, TCD has revealed a possible association of poor neurological outcome with intraoperative cerebral emboli and impaired cerebral perfusion. However, to date, there is no evidence that routine use of transcranial Doppler can improve neurological outcome after cardiac surgery.
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Fouquet O, Dang Van S, Baudry A, Meisnerowski P, Robert P, Pinaud F, Binuani P, Chrétien JM, Henrion D, Baufreton C, Loufrani L. Cardiopulmonary bypass and internal thoracic artery: Can roller or centrifugal pumps change vascular reactivity of the graft? The IPITA study: A randomized controlled clinical trial. PLoS One 2020; 15:e0235604. [PMID: 32645079 PMCID: PMC7347139 DOI: 10.1371/journal.pone.0235604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory response (SIRS) and affects the organ vascular bed. Experimentally, the lack of pulsatility alters myogenic tone of resistance arteries and increases the parietal inflammatory response. The purpose of this study was to compare the vascular reactivity of the internal thoracic arteries (ITAs) due to the inflammatory response between patients undergoing coronary artery bypass grafting (CABG) under CPB with a roller pump or with a centrifugal pump. Methods Eighty elective male patients undergoing CABG were selected using one or two internal thoracic arteries under CPB with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples were collected before starting CPB (Time 1) and before the last coronary anastomosis during aortic cross clamping (Time 2). The primary endpoint was the endothelium-dependent relaxation of ITAs investigated using wire-myography. The secondary endpoint was the parietal inflammatory response of arteries defined by the measurements of superoxide levels, leukocytes and lymphocytes rate and gene expression of inflammatory proteins using. Terminal complement complex activation (SC5b-9) and neutrophil activation (elastase) analysis were performed on arterial blood at the same times. Results Exposure time of ITAs to the pump flow was respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP group. Acetylcholine-dependent relaxation was conserved in the two groups whatever the time. Gene expression of C3 and C4a in the artery wall decreased from Time 1 to Time 2. No oxidative stress was observed in the graft. There was no difference between the groups concerning the leukocytes and lymphocytes rate. SC5b-9 and elastase increased between Time 1 and Time 2. Conclusion Endothelium-dependent relaxation of the internal thoracic arteries was preserved during CPB whatever the type of pump used. The inflammatory response observed in the blood was not found in the graft wall within this time frame. Trial registration Name of trial study protocol: IPITA Registration number (ClinicalTrials.gov): NCT04168853.
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Affiliation(s)
- Olivier Fouquet
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
- * E-mail:
| | - Simon Dang Van
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Anna Baudry
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Philippe Meisnerowski
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Pauline Robert
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Frédéric Pinaud
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Patrice Binuani
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | | | - Daniel Henrion
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Christophe Baufreton
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Laurent Loufrani
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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