Regional cerebral perfusion and brain water content after operative myocardial revascularisation in an adult porcine model: effect of cerebral emboli formations

Objectives: Emboli generation during cardiac surgery contributes to neurocognitive outcome. Our aim was to determine the effects emboli formation on cerebral blood-flow and brain-water content after different surgical techniques for myocardial revascularisation. Methods: In swine a mammarian artery to LAD bypass was constructed using CPB with cardioplegic arrest, OPCAB or Impella®-supported OPCAB (each n=9). 9 animals received a sham-operation. Emboli-count in the right common carotid artery was monitored. Regional cerebral-perfusion (RCP) was assessed from different cerebral regions with fluorescent microspheres. Hemodynamics and arterial blood-gases were recorded. These variables were analyzed before, during and four hours after surgery. Finally brain-water content (BWC) was determined. Results: Only during CPB and Impella-assistance a significant amount of embolies was registrated (CPB: 244±45, OPCAB: 21±7 Impella: 1391±337 and control: 42±33) (p