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Retinal and Cerebral Microembolisation and Neuro-endocrine Dysfunction During Coronary Artery Bypass Surgery

其他書名	Two Prospective Randomized Trials
出版	University of Bristol, 2011
URL	http://books.google.com.hk/books?id=fcMljwEACAAJ&hl=&source=gbs_api

註釋Coronary artery bypass grafting is a well established treatment for coronary artery disease. Traditionally it has been done using cardiopulmonary bypass. During last decades off pump coronary surgery has established itself as a safe and effective way of performing coronary revascularization. Midterm and long term results also have been published from this institute which showed equivalent outcome in terms of graft patency rate as well as long term survival and cardiac related morbidity. Off pump surgery have the theoretical advantages of avoiding cardiopulmonary bypass which exposes blood to artificial surfaces which intern activates inflammatory responses with its adverse effects. Performing coronary artery bypass surgery off pump also have the advantage of avoiding procedures like cannulations and cross clamping of aorta which are associated with inherent risk of cerebral embolism. In the first part of the study 20 patients were randomized to either on pump CABG or off pump CABG (10 in each group). The cerebral micro embolism were assessed by transcranial Doppler, retinal micro embolism were assessed by fluorescent retinal angiography and fundus photography, neurological injury were assessed by S100B protein level in serum. The ophthalmic functions were assessed by testing visual acuity and field of vision. 50% of patients in the on pump group showed features of retinal microembolism in fluorecent retinal angiogram where as none of the patients in the off-pump group showed retinal microembolism. On pump patients had higher number of HITS in trans-cranial Doppler. Serum level of S100b was also higher in on pump patient. Because the retina develops as an outgrowth from brain it can be inferred that similar changes do occur in the intracranial vasculature.