Page 31 - ANZCP Gazette May 2023

4 Perfusion Table 1. Patient demographics, EuroSCORE II, and selected details of cardiopulmonary bypass management.17.
Factor
Age (years)
Gender (male/female)
Body surface area (m2) EuroSCORE II
Bypass time (minutes)c
Aortic cross-clamp time (minutes)d
Open chamber (n = 20) mean (SDa), median (IQRb) or numbers
Closed chamber (n = 20) mean (SDa), median (IQRb) or numbers
63.3 (8.3)
20/0
2.1 (0.2)
0.9 (0.7–1.4) 81.5 (64.5–91.0) 55.5 (44.5–66.0)
64.7 (12.3)
19/1
2.1 (0.2)
1.1 (0.8–2.0)
96.5 (65.5–159.0) 70.5 (46.0–74.5)
aStandard Deviation.
bInterquartile Range.
cTwo patients in each procedural group had two bypass periods. dOne patient in each procedural group had two cross-clamp periods.
an interaction between group and side (p = 0.001), indi- cating that the effect of group differed in the right and left hemispheres. In the right hemisphere, the OCS group had a significantly greater increase in Mx than the CCS group (md: 0.15, 95% CI: 0.02, 0.27; p = 0.03) (Figure 2), whilst the change in Mx did not significantly differ between groups in the left hemisphere (md: 0.02, 95% CI: −0.11, 0.15; p = 0.77) (Figure 3). There was a significant increase in Mx after cross-clamp removal in the OCS group but not the CCS group. The increase in the OCS group was driven by the change in the right side (p = 0.004), with the right side difference in the CCS not being significant.
Discussion
To our knowledge, this is the first study to evaluate the effect of exposure to cerebral arterial emboli on cerebral
Figure 1. Pre–post aortic cross-clamp removal difference in Mx overall (both hemispheres), with mean and 95% CI. Comparison is of mean pre-post change between groups.
Table 2. Summary of emboli counts and Mx in the relevant periods by patient group and side.
Emboli count Median (IQRa)
Initiation of CPB
to cross-clamp Time period removal
Open chamber group
30 mins after cross-clamp removal
1631 (606, 2296) 826 (371, 1622) 495 (209, 796)
229 (142, 384) 181 (66, 276) 79 (45, 143)
Mxc
Mean (SDb)
30 mins before 30 mins after cross-clamp cross-clamp
Total
Right
Left
Closed chamber group
Total Right Left
aInterquartile Range. bStandard Deviation. cMean velocity Index.
353 (199, 770) 272 (162, 630) 59 (37, 152)
617 (163, 970) 455 (100, 685) 127 (64, 331)
Total
2664 (793, 3734) 1430 (483, 2738) 600 (310, 1118)
775 (415, 1211) 536 (269, 1029) 149 (113, 351)
removal (pre)
0.32 (0.23) 0.31 (0.25) 0.33 (0.22)
0.46 (0.18) 0.48 (0.17) 0.44 (0.20)
removal (post)
0.42 (0.16) 0.45 (0.16) 0.39 (0.18)
0.48 (0.17) 0.47 (0.17) 0.48 (0.18)
Change
0.10 (0.20) 0.14 (0.19) 0.07 (0.23)
0.02 (0.21) −0.01 (0.20) 0.05 (0.23)
MAY 2023 | www.anzcp.org 28