Reduction of neurologic complications by intra-aortic filtration in patients undergoing combined intracardiac and CABG procedures

Abstract

Objective: Patients undergoing combined intracardiac and coronary artery bypass grafting (CABG) procedures are at high risk for neurologic events. Previously the Multicenter Study of Perioperative Ischemia (McSPI) Study Group demonstrated that risk factors for neurologic complications in these patients related primarily to embolization.

Objective: This study investigated risk factors and outcomes in 185 high-risk patients receiving intra-aortic filtration during combined intracardiac and CABG procedures.

Methods: Seventeen European centers comprising the International Council of Emboli Management (ICEM) pooled data on patients receiving intra-aortic filtration (EMBOL-X, Mountain View, CA, USA) into a consecutive enrollment registry. Preoperative, intraoperative, and outcome variables were compared between ICEM patients undergoing combined CABG and intracardiac procedures and the corresponding McSPI subgroup.

Results: Type I outcomes (stroke, transient ischemic attack, coma, death due to neurologic causes) occurred in 2.2% (4/185) of ICEM patients compared to 8.4% (23/273) of McSPI patients. No ICEM patient suffered a fatal stroke compared with five in the McSPI study (1.8%). One nonfatal stroke was observed in the ICEM group (0.5%) and 16 were observed in the McSPI group (5.9%). Three patients (1.6%) were reported with transient ischemic attack in the ICEM group, compared to two in the McSPI study (0.7%). One of the reported patients in the ICEM group with transient ischemic attack also suffered a coma that was still evident at discharge. In all, four patients suffered Type I neurologic events in the ICEM group (2.2%), compared to 23 in the McSPI group (8.4%). In the ICEM study group, four patients (2.2%) died due to non-neurologic causes, compared to 18 in the McSPI group (6.6%).

Conclusions: Even with a significantly worse preoperative profile, high-risk patients receiving intra-aortic filtration suffered Type I cerebral injury 74% less often than patients in the McSPI group.