title: Minimized cardiopulmonary bypass reduces retinal microembolization: a randomized clinical study using fluorescein angiography.
abstract: BACKGROUND
  The use of minimized cardiopulmonary bypass (MCPB) circuits has recently increased in an attempt to reduce the adverse effects of CPB. This prospective randomized study aimed to determine the effects of MCPB on retinal microembolization and related inflammatory, coagulation, and endothelial markers compared with conventional extracorporeal circulation (CCPB) among patients undergoing coronary artery bypass graft surgery.
  
  
  METHODS
  Forty patients entered, and 37 patients completed the study. After the induction of anesthesia and immediately after the termination of CPB, standardized retinal fluorescein angiographs and digital images were obtained on both eyes and analyzed in a blinded fashion in terms of the CPB circuit. Blood samples for inflammatory, coagulation, and endothelial markers were collected at eight time points until the third postoperative day.
  
  
  RESULTS
  Postperfusion retinal fluorescein angiographs revealed microembolic perfusion defects in 2 of 18 in the MCPB group and in 9 of 18 in the CCPB group (p=0.027 [11% vs. 50%, difference 39%, confidence interval: 0.087 to 0.613, p=0.029]). Activation of polymorphonuclear leukocytes as measured with polymorphonuclear elastase was significantly decreased in the MCPB group. Other markers of inflammation, coagulation, and endothelial dysfunction increased comparably in both groups during CPB.
  
  
  CONCLUSIONS
  Retinal microembolization was found to be decreased after the use of minimized CPB compared with CCPB, suggesting a decreased embolic load to the brain after MCPB.
authors.affiliation: Department of Anesthesiology and Surgery, Division of Anesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland. riikka.rimpilainen@oulu.fi
authors.forename: Riikka
authors.initials: R
authors.lastname: Rimpiläinen
authors.forename: Nina
authors.initials: N
authors.lastname: Hautala
authors.forename: Juha K
authors.initials: JK
authors.lastname: Koskenkari
authors.forename: Jussi
authors.initials: J
authors.lastname: Rimpiläinen
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
authors.forename: Heljä-Marja
authors.initials: HM
authors.lastname: Surcel
authors.forename: Eeva-Riitta
authors.initials: ER
authors.lastname: Savolainen
authors.forename: Martti
authors.initials: M
authors.lastname: Mosorin
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D004617:Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011859:Radiography; D012164:Retinal Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000517:prevention & control*; D012171:Retinal Vessels; D012307:Risk Factors