Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial.

Basciani, Reto Marco; Kröninger, Felix; Gygax, Erich; Jenni, Hansjörg; Reineke, David Christian; Stucki, Monika Pia; Hagenbuch, Niels; Carrel, Thierry; Eberle, Balthasar; Erdös, Gabor (2016). Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial. Artificial organs, 40(12), E280-E291. Wiley-Blackwell 10.1111/aor.12744

[img] Text
aor12744.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (618kB) | Request a copy

To compare intraoperative cerebral microembolic load between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) during isolated surgical aortic valve replacement (SAVR), we conducted a randomized trial in patients undergoing primary elective SAVR at a tertiary referral hospital. The primary outcome was the procedural phase-related rate of high-intensity transient signals (HITS) on transcranial Doppler ultrasound. HITS rate was used as a surrogate of cerebral microembolism in pre-defined procedural phases in SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with integrated arterial filter. Forty-eight patients were randomized in a 1:1 ratio to MiECC or CECC. Due to intraprocedural Doppler signal loss (n = 3), 45 patients were included in final analysis. MiECC perfusion regimen showed a significantly increased HITS rate compared to CECC (by a factor of 1.75; 95% confidence interval, 1.19-2.56). This was due to different HITS rates in procedural phases from aortic cross-clamping until declamping [phase 4] (P = 0.01), and from aortic declamping until stop of extracorporeal perfusion [phase 5] (P = 0.05). Post hoc analysis revealed that MiECC-F generated a higher HITS rate than CECC+F (P = 0.005), CECC-F (P = 0.05) in phase 4, and CECC-F (P = 0.03) in phase 5, respectively. In open-heart surgery, MiECC is not superior to CECC with regard to gaseous cerebral microembolism. When using MiECC for SAVR, the use of oxygenators with integrated arterial line filter appears highly advisable. Only with this precaution, MiECC confers a cerebral microembolic load comparable to CECC during this type of open heart surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Basciani, Reto Marco; Kröninger, Felix; Gygax, Erich; Reineke, David Christian; Stucki, Monika Pia; Carrel, Thierry; Eberle, Balthasar and Erdös, Gabor

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0160-564X

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

12 Jul 2016 09:07

Last Modified:

23 Jan 2018 12:13

Publisher DOI:

10.1111/aor.12744

PubMed ID:

27283935

Uncontrolled Keywords:

Aortic stenosis; Extracorporeal circulation; Gaseous microemboli; Surgical aortic valve replacement

BORIS DOI:

10.7892/boris.83713

URI:

https://boris.unibe.ch/id/eprint/83713

Actions (login required)

Edit item Edit item
Provide Feedback