Transcranial Doppler emboli count predicts rise in creatinine after coronary artery bypass graft surgery

Abstract

Objective: To examine the correlation between transcranial Doppler ultrasonography-detected emboli during coronary artery bypass graft surgery with cardiopulmonary bypass and renal dysfunction as determined by the postoperative change in creatinine.

Design: Retrospective review of data from the anesthesia and cardiothoracic surgery databases.

Setting: Tertiary care university hospital.

Participants: Two hundred eighty-six patients undergoing coronary artery bypass graft surgery.

Interventions: Transcranial Doppler ultrasonography of the right middle cerebral artery was performed after induction of general anesthesia through completion of the operation. Doppler signals were recorded and emboli counts determined using an automated counting system.

Measurements and main results: Renal dysfunction was assessed as the change in creatinine from the preoperative value to the maximum postoperative value (Delta-Cr). There was a significant (p = 0.0003) univariate correlation between postoperative change in creatinine and total number of Doppler-detected emboli. The effect of total number of emboli remained significant (p = 0.0038) in the multivariable analysis after adjustment for covariables (age, sex, number of grafts, left ventricular ejection fraction, hypertension, history of congestive heart failure, diabetes, cardiopulmonary bypass time, preoperative creatinine, and maximum postoperative creatinine).

Conclusions: Increased numbers of Doppler-detected emboli during coronary artery bypass graft surgery are associated with postoperative renal dysfunction.