Hedberg Magnus, Funck Bertil, Engström Karl Gunnar
Department of Surgical and Perioperative Science, Heart Center, Cardiothoracic Division, Umeå University Hospital, Umeå, Sweden.
J Card Surg. 2008 Jan-Feb;23(1):39-43. doi: 10.1111/j.1540-8191.2007.00481.x.
Aortic cannulation during cardiac surgery is a potential etiological factor for perioperative stroke. Cannulae may dislodge aortic-wall calcifications. In addition, the sharp edge of the cannula-tip may shear off vessel-wall tissue, which can be expelled into the lumen. This hypothesis concerning source of emboli was tested in a noncalcified aortic perfusion model.
Pig aortas were pressurized and cannulated. Washout samples were collected before and after cannulation (n = 40). Particles were deposited onto a 10-microm filter and evaluated by microscopy and digital image analysis.
A higher incidence of particles generated by cannulation was noted as compared to before the maneuver (p < 0.001). This increase included small (<0.1 mm, p < 0.001) and intermediate-size particles (0.1-0.5 mm, p < 0.001). Particles above 0.5 mm were few and were not associated with cannulation.
Cannulation was a source of embolic material in the noncalcified aortic model. However, these particles were less than 0.5 mm in diameter and may contribute to neurocognitive decline after cardiac surgery.
心脏手术期间的主动脉插管是围手术期卒中的一个潜在病因。插管可能会使主动脉壁钙化脱落。此外，插管尖端的锐利边缘可能会剪切血管壁组织，这些组织可能会被排入管腔。在一个非钙化主动脉灌注模型中对这一关于栓子来源的假设进行了验证。
对猪主动脉进行加压并插管。在插管前后收集冲洗样本（n = 40）。将颗粒沉积在一个10微米的滤膜上，并通过显微镜检查和数字图像分析进行评估。
与操作前相比，插管产生颗粒的发生率更高（p < 0.001）。这种增加包括小颗粒（<0.1毫米，p < 0.001）和中等大小颗粒（0.1 - 0.5毫米，p < 0.001）。大于0.5毫米的颗粒很少，且与插管无关。
在非钙化主动脉模型中，插管是栓子材料的一个来源。然而，这些颗粒直径小于0.5毫米，可能会导致心脏手术后神经认知功能下降。
