Is there any impact of the shape of aortic end-hole cannula on stroke occurrence? Clinical evaluation of straight and bent-tip aortic cannulae

Abstract

Objective: To compare the impact of straight and bent-tip aortic cannulae on stroke occurrence, location, and severity.

Methods: Prospective data were collected on 8129 patients (coronary artery bypass grafting (CABG) and/or valvular surgery). ‘Bent-tip’ aortic cannulae were used in 15.6% of cases and ‘straight’ end-hole cannulae in 84.4% of cases.

Results: There were a total of 137 strokes: right anterior 52, left anterior 39, bilateral 23, posterior 18, and location not established5. With the use of bent-tip cannulae, the incidence of strokes was 0.9% versus 1.8% with straight cannulae (c², p=0.026). Bilateral and posterior strokes occurred more often with the use of straight cannulae (c², p = 0.015). Straight cannulae also related to the severity of strokes (c², p = 0.003).

Conclusions: There is an influence of the type of cannula on the occurrence, location, and severity of strokes. Straight cannulae cause significantly more often and more severe bilateral and posterior strokes than bent-tip cannulae.

Get full access to this article

View all access options for this article.

References

Baker R , Andrew M , Knight J. Evaluation of neurologic assessment and outcomes in cardiac surgical patients . Semin Thorac Cardiovasc Surg 2001; 13: 149-157 .

Roach G , Kanchuger M , Mangano CM et al. Adverse cerebral outcomes after coronary bypass surgery . N Engl J Med 1996; 335: 1857-1863 .

Hogue CW Jr , Murphy SF , Schechtman KB , Dávila-Román VG. Risk factors for early or delayed stroke after cardiac surgery . Circulation 1999; 100: 642-647 .

Culliford AT , Colvin SB , Rohrer K , Baumann FG , Spencer FC. The atherosclerotic ascending aorta and trans-verse arch: a new technique to prevent cerebral injury during bypass: experience with 13 patients . Ann Thorac Surg 1986; 41: 27-35 .

Barbut D , Lo YW , Hartman GS et al. Aortic atheroma is related to outcome but not numbers of emboli during coronary bypass . Ann Thorac Surg 1997; 64: 454-459 .

Blauth CI , Cosgrove DM , Webb BW et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery . J Thorac Cardiovasc Surg 1992; 103: 1104-1112 .

Weinstein GS. Left hemispheric strokes in coronary surgery: implications for end-hole aortic cannulas . Ann Thorac Surg 2001; 71: 128-132 .

Struck E , De Vivie ER , Hehrlein F et al. Multicentric quality assurance in cardiac surgery. Quadra study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality retrospective analysis) . Thor-ac Cardiovasc Surg 1990; 38: 123-134 .

Schirmer U , Dietrich W , Lüth JU , Baulig W. Der erweiterte Datensatz Kardioanästhesie . Anästhesiol Intensivmed 2000; 41: 683-691 .

10.

Caplan LR , Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke . Arch Neurol 1998; 55: 1475-1482 .

11.

Barbut D , Grassineau D , Lis E , Heier L , Hartman GS , Isom OW. Posterior distribution of infarcts in strokes related to cardiac operations . Ann Thorac Surg 1998; 65: 1656-1659 .

12.

Hill AB , Obrand D , O’Rourke K , Steinmetz OK , Miller N. Hemispheric stroke following cardiac surgery: a case-control estimate of the risk resulting from ipsilateral asymptomatic carotid artery stenosis . Ann Vasc Surg 2000; 14: 200-209 .

13.

Dashe JF , Pessin MS , Murphy RE , Payne DD. Carotid occlusive disease and stroke risk in coronary artery bypass graft surgery . Neurology 1997; 49: 678-686 .

14.

Ricotta JJ , Faggioli GL , Castilone A , Hassett JM. Risk factors for stroke after cardiac surgery: Buffalo Cardiac - Cerebral Study Group . J Vasc Surg 1995; 21: 359-364 .

15.

Magilligan DJ Jr , Eastland MW , Lell WA , DeWeese JA , Mahoney EB. Decreased carotid flow with ascending aortic cannulation . Circulation 1972; 45(suppl I): I-130-I-133 .

16.

Benaroia M , Baker AJ , Mazer CD , Errett L. Effect of aortic cannula characteristics and blood velocity on transcranial Doppler-detected microemboli during cardiopulmonary bypass . J Cardiothorac Vasc Anesth 1998; 12: 266-269 .

17.

Houbert-Huebner E , Gerdes A , Sievers HH. An in vitro evaluation of a new cannula tip design compared with two clinically established cannula-tip designs regarding aortic arch vessel perfusion characteristics . Perfusion 2000; 15: 69-76 .

18.

Caplan LR , Hier DB , D’Cruz I. Cerebral embolism in the Michael Reese Stroke Registry . Stroke 1983; 14: 530-536 .

19.

Jacobs A , Neveling M , Horst M et al. Alterations of neuropsychological function and cerebral glucose metabolism after cardiac surgery are not related only to intraoperative microembolic events . Stroke 1998; 29: 660-667 .