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Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series


1 Department of Cardiothoracic Surgery, Cardiothoracic Unit, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom
2 Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom
3 Department of Cardiac Anaesthesia, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom

Correspondence Address:
Pankaj Kumar Mishra
Department Cardiothoracic Surgery, Cardiothoracic Unit, Heart and Lung Centre, Wolverhampton, WV10 0QP
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.173021

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Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 59-62

 

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Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.






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1 Department of Cardiothoracic Surgery, Cardiothoracic Unit, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom
2 Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom
3 Department of Cardiac Anaesthesia, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom

Correspondence Address:
Pankaj Kumar Mishra
Department Cardiothoracic Surgery, Cardiothoracic Unit, Heart and Lung Centre, Wolverhampton, WV10 0QP
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.173021

Rights and Permissions

Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.






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