Etiology and Prevention of brain function disorder often cordiovascular surgery

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By searching previous reports concerning the incidence and clinical characteristics of brain function disorder following cardiac and aortic surgeries, we examined to analyze the etiology and preventative measure in brain damage in association with cardiovascular surgery. The incidence of stroke is reported to be 1%-5% after cardiac surgery, whereas that of brain function disorder including cognitive function is 30%-80%. Embolic events, changes in cerebral blood flow, global hypoperfusion, cerebral reperfusion injury, and CPB-triggered whole body inflammatory response represent possible mechanisms. We evaluated our new method for removal of retained air at the termination of cardiopulmonary bypass under the monitoring of end-tidal CO_2 pressure (P_<ET>CO_2), pulmonary arterial pressure (PAP) and transesophageal two-dimensional cardiography (TEE). The Reservoir of the cardiopulmonary bypass was gradually raised to decrease the venous drainage. Accordingly, the right heart began to receiv … More e the venous blood and eject it to the pulmonary artery. The vent existing in the left ventricle or the left atrium then collected any whole blood containing air bubbles that came from the pulmonary circulation. The air bubbles were confirmed to be removed and not to eject from the left ventricle to the systemic circulation by TEE. P_<ET>CO_2 reached 28 ± 4 mmHg during the removal of air, whereas the simultaneous PaCO_2 of 35 ± 6 mmHg (P<0.05). The duration time of removal of air was 9 ± 2 min. The P_<ET>CO_2 and PAP are useful indicators of pulmonary circulation during our procedure for removal of air. P_<ET>CO_2 of 25-30 mmHg and PAP of 90% of the prebypass level have been found to be necessary for the removal of air. It is suggested that our technique for removal of air using P_<ET>CO_2, PAP and TEE enables us to satisfactorily eliminate residual air. However, these methods could not significantly decrease the incidence of brain function disorder following cardiac surgery. From these, We conclude that atherosclerotic and fat embolisms and a decrease in cerebral blood flow during CPB may be important for genesis of brain damage during and after cardiac surgery. Less