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![Transcranial Doppler recordings of the left middle cerebral artery show embolic signals. The high-intensity transient signals (HITS) seen with emboli are indicated by arrows [13]. Reproduced with permission from Thieme](publication/355393197/figure/fig2/AS:1122853973962792@1644720657617/Transcranial-Doppler-recordings-of-the-left-middle-cerebral-artery-show-embolic-signals.png)
Transcranial Doppler recordings of the left middle cerebral artery show embolic signals. The high-intensity transient signals (HITS) seen with emboli are indicated by arrows [13]. Reproduced with permission from Thieme
Source publication
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...
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Methods
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Background
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Citations
... The MCA is ideal for TCD monitoring and is the only intracranial vessel used for continuous intraoperative Doppler monitoring. TCD can serve as a tool for effectively monitoring cerebral embolic events [23]. Microemboli entering the cerebral circulation appear to be among the most common causes of stroke or neurological complications during CABG surgery. ...
Introduction:
Cerebrovascular events after cardiac surgery are among the most serious complications, related to a greater risk of patient mortality. This problem can occur following the formation of gas emboli during open heart surgery.
Aim:
To address all the mechanisms that can lead to embolic events after cardiovascular surgery, how to manage them and how to possibly prevent them.
Material and methods:
A search of the PubMed database was conducted. We reviewed the clinical literature and examined all aspects to identify the root causes that can lead to the formation of emboli.
Results:
Among the studies reviewed, it was found that the main causes include manipulation of the aorta, inadequate deaeration after cardiac surgery, and blood-component contact of extracorporeal circulation. It has been reported that gas emboli can lead to deleterious damage such as damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adhesion, and fibrin deposition in the microvascular system.
Conclusions:
Stroke after cardiovascular surgery is one of the most important complications, with a great impact on operative mortality and patient survival. Efforts have been made over time to understand all the pathophysiological mechanisms related to this complication, with the aim of reducing its incidence. One of the goals should be to improve both the surgical technique and the perfusion modality and minimize the formation of air bubbles or to facilitate their elimination during the cardiopulmonary bypass procedure.
... However, to date, there is no evidence that routine use of transcranial Doppler can improve neurologic outcomes after cardiac surgery. 18 In patients in whom CT reveals obstructive carotid disease, they can be pretreatmed with stenting of the carotid vessels 19,20 or even in a hybrid approach. 21 In other cases in which surgery is seen as too high risk, patients can be referred back to the heart team to investigate if, with current knowledge, patients also can be treated percutaneously. ...
Objective:
Stroke remains a devastating complication after cardiac surgical procedures despite perioperative monitoring and management advances. This study aimed to determine the predictors of stroke in a large, contemporary coronary artery surgery population.
Design:
Patient data were analyzed retrospectively.
Setting:
This single-center study was performed in the Catharina Hospital (Eindhoven).
Participants:
All patients who underwent isolated coronary artery bypass grafting (CABG) between January 1998 and February 2019 were included.
Interventions:
Isolated CABG.
Measurements and main results:
The primary endpoint was a postoperative stroke, defined according to the international updated definition for stroke. Logistic regression was performed to retrieve variables associated with postoperative stroke. A total of 20,582 patients underwent CABG during the period of the study. Stroke was observed in 142 patients (0.7%), of which 75 (52.8%) occurred during the first 72 hours. The incidence of postoperative stroke declined over the years. A significantly higher 30-day mortality rate was seen in patients with stroke (20.4%) compared with 1.8% in the rest of the population; p < 0.001. Multivariate logistic regression analysis showed age, peripheral arterial disease, reexploration for bleeding, perioperative myocardial infarction, and year of surgery as independent predictors for stroke. Patients with postoperative stroke had worse long-term survival (log-rank p < 0.001). Cox regression analysis revealed postoperative stroke (odds ratio 2.13 [1.73-2.64)) as an independent predictor of late mortality.
Conclusions:
Stroke after CABG is associated with high early and late mortality. Age, peripheral vascular disease, and the year of surgery were associated with postoperative stroke.
