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Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery

Department of Cardiac Surgery, University Hospital Munich Grosshadern, Germany, Sandra.Eifert{at}hch.med.uni-muenchen.de

H Reichenspurner

Department of Cardiothoracic Surgery, University of Hamburg, Germany

T Pfefferkorn

Department of Neurology, University Hospital Munich Grosshadern, Germany

B Baur

Department of Neurology, University Hospital Munich Grosshadern, Germany

C von Schlippenbach

Department of Neurology, University Hospital Munich Grosshadern, Germany

T E Mayer

Department of Neuroradiology, University Hospital Munich Grosshadern, Germany

G Hamann

Department of Neurology, University Hospital Munich Grosshadern, Germany

B Reichart

Department of Cardiac Surgery, University Hospital Munich Grosshadern, Germany

Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic filter device has an effect on the magnet resonance imaging (MRI) and functional neurological outcome.

Twenty-four patients undergoing cardiosurgical procedures using cardiopulmonary bypass (CPB) were selected: coronary artery bypass graft (CABG) surgery (n=17), aortic valve replacement (AVR) surgery (n= 4) or combined procedures (n=3). Patients were evaluated by diffusion weighted MRI of the brain, neurological examination and neuropsychological assessment regarding alertness as well as divided and selective attention before and five to seven days after surgery. The patients were divided into two groups. In group I, 12 patients received a filter through a modified 24 F arterial cannula immediately before the aortic crossclamp was released. Filters remained in the aorta until CPB was discontinued. Intraoperatively, bilateral middle cerebral artery transcranial Doppler (TCD) was monitored at baseline, at the beginning of CPB, at a timepoint when the aorta was crossclamped, when the filter was inserted and while the crossclamp was switched to partial clamping until the CPB was discontinued. TCD was used for detection of microembolic signals (MES). The captured material in the filter was examined histologically. Twelve patients served as controls without aortic filtration (group II).

The MRI of the brain did not show any diffusion alterations in either group before or after surgery. No patient developed a focal neurological deficit or stroke. Intraoperative quantitative MES detection revealed a four to tenfold increase in patients of group I compared with group II (5 - 6 versus 0.5 - 1 MES/min) during the filter dwell time. There was no consistent pattern regarding the neurobehavioural sequelae. Filters showed arteriosclerotic debris in 75% of the patients.

The use of the intra-aortic filter device did not show a positive effect on neurological, neuroradiographical and neuropsychological outcomes. The increase of the MES rate in group I patients may be due to microbubbles generated as microcavitations by the filter or the aortic filter cannula. The intra-aortic filter was able to capture atheromatous material in 75% of the patients.

Perfusion, Vol. 18, No. 1 suppl, 55-60 (2003)
DOI: 10.1191/0267659103pf628oa


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