title: Brain emboli distribution and differentiation during cardiopulmonary bypass.
abstract: OBJECTIVE
  Cardiopulmonary bypass (CPB) is a lifesaving practice in cardiac surgery, but its use frequently is associated with cerebral injury and neurocognitive dysfunctions. Despite the involvement of numerous factors, microembolism occurring during CPB seems to be one of the main mechanisms leading to such alterations. The aim of the present study was to characterize the occurrence of cerebral microembolism with reference to microembolic amount, nature, and distribution in different combinations of cardiac procedures and CPB on the microembolic load.
  
  
  METHODS
  A retrospective observational clinical study.
  
  
  METHODS
  A single-center regional hospital.
  
  
  METHODS
  Fifty-five patients undergoing elective cardiac surgery with CPB.
  
  
  METHODS
  Bilateral detection of the patients' middle cerebral arteries using a multifrequency transcranial Doppler.
  
  
  RESULTS
  Patients were divided into 3 groups depending on the CPB circuit used (open, open with vacuum, or closed). There was a significant difference between the number of solid and gaseous microemboli (p<0.001), with the solid lower than the gaseous ones. The number of solid microemboli was affected by group (p< 0.05), CPB phase (p<0.001), and laterality (p<0.01). The number of gaseous microemboli was affected only by group (p<0.05) and CPB phase (p<0.001). Generally, the length of CPB phase did not affect the number of microemboli.
  
  
  CONCLUSIONS
  Surgical procedures combined with CPB circuits, but not the CPB phase length, affected the occurrence, nature, and laterality of microemboli.
authors.affiliation: Department of Anesthesia and Intensive Care, Treviso Regional Hospital, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanatta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Forti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Comin
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Mazzarolo
authors.forename: Mwaba
authors.initials: M
authors.lastname: Chilufya
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Baldanzi
authors.forename: Enrico
authors.initials: E
authors.lastname: Bosco
authors.forename: Carlo
authors.initials: C
authors.lastname: Sorbara
authors.forename: Elvio
authors.initials: E
authors.lastname: Polesel
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004618:Embolism, Air / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies
keywords: cardiac surgery; cardiopulmonary bypass; cerebral microembolism; transcranial Doppler