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O-53 Transcranial Doppler microembolic signals and serum S100β during transcatheter aortic valve implantation
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ammadex and neostigmine administration to 90% recovery of the TOF ratio was recorded. Results. The two groups demonstrated similar demographic characteristics and none of the patients needed ventilatory assistance during the postoperative period. Both agents proved equally efficient in reversing NMB although a significant difference was recorded between the two groups. The mean time for 90% recovery of the TOF ratio after neostigmine administration was 9.7 min while that of sugammadex did not exceed 2.8 min (P⬍0.05).
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Discussion. Sugammadex seems to be superior to neostigmine as a reversal agent of rocuronium-induced intense NMB leading to a more rapid reappearance of normal muscle activity in these patients with their highly increased sensitivity to non-depolarizing neuromuscular blocking drugs [1]. REFERENCE 1. Briggs ED, Kirsch JR. Anesthetic implications of neuromuscular disease. J Anesth 2003; 17: 177-85.
Oral Session IX – Cardiac Anaesthesia O-53 Transcranial Doppler microembolic signals and serum S100 during transcatheter aortic valve implantation Björn Reinsfelt, Anne Westerlind, Dan Ioanes, Henrik Zetterberg, Sven-Erik Ricksten Sahlgrenska University Hospital, Gothenburg, Sweden Introduction. Transcatheter aortic valve implantation (TAVI) is an alternative treatment of aortic stenosis in high-risk patients rejected for an open valve procedure. TAVI induces mechanical stress to the aorta and aortic valve by catheter manipulation, balloon dilatation and valve insertion. Concerns regarding risk of cerebral embolization have been raised [1]. We assessed the impact of TAVI on the cerebral microembolic load by transcranial Doppler (TCD) and on the release of S100 in serum, an established marker of injury to astroglial cells. We hypothesized that the TAVI procedure causes a microembolic load that correlates to CNS injury as assessed by release of S-100. Method. Eleven patients treated with TAVI (CoreValve®) were included. The right medial cerebral artery was insonated using power M-mode TCD. Two physicians independently evaluated the TCD files and identified true microembolic signals. Blood sampling for S100 was performed before the procedure and at 1, 2, 4, 6, 12, and 24 hrs after balloon dilatation of the native valve. Area under the curve (AUC) relating time to S100 concentration was correlated to the embolic load (Spearman correlation).
Results. Mean embolic load was 288 ⫾ 43. All patients had a peak increase of S100 (177⫾26%) within the first hour after
balloon dilatation (fig). Embolic load correlated positively to 24 hr AUC for S100 (r⫽0.697, P⬍0.05). Discussion. We have shown that TAVI induces substantial cerebral microembolization causing CNS cell injury, which is directly correlated to the degree of microembolization. Efforts should be made to limit the cerebral embolic load during TAVI. REFERENCE 1. Dittrich R, Ringelstein EB. Occurrence and clinical impact of microembolic signals during or after cardiosurgical procedures. Stroke 2008; 39: 503-11. O-54 N-acetylcysteine for prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) Glauco Juliano, Claudio Brambillasca, Sebastiana Gregu, Stefano Salis
Guido
Merli,
Centro Cardiologico IRCCS Monzino, Milano, Italy Introduction. N-acetylcysteine (NAC) has been proposed to prevent both contrast-induced nephropathy and acute kidney injury (AKI) with controversial results after cardiac surgery. The aim of the study was to assess the effect of NAC in preventing AKI in patients with preoperative impaired renal function undergoing TAVI. Method. We enrolled 135 patients with preoperative renal function impairment (creatinine clearance ⬍60 ml/min) undergoing TAVI. Patients were randomized to receive NAC (n⫽61) or to be a control group (n⫽74). Patients of the NAC group received NAC (1200 mg iv. every 8 hours starting immediately before surgery). Further worsening of renal function was considered according AKIN classification. Results were analysed with t-test or 2 - test when required. P⬍0.05 was considered significant. The sample size was adequate for ␣ 0.05, with a power of the study ⬎80% Results. No differences were found between the two groups in the main preoperative data: age (P⫽0.95), sex distribution (P⫽0.20), weight (P⫽0.35), EuroSCORE (P⫽0.06), creatinine (P⫽0.11), creatinine clearance (P⫽0.95), echocardiographic left ventricle ejection fraction (P⫽0.70), pressure gradient through aortic valve (P⫽0.56). Nine patients in the control group (12%) and nine in the NAC group (14%) developed postoperative AKI, with no significant difference (P⫽0.65). Three patients with AKI in the control group (4%) and four in the NAC group (6%) required renal replacement treatment, with no significant differences (P⫽0.51). Discussion. Previous papers proposed N-acetylcysteine to prevent contrast-induced nephropathy or AKI after cardiac surgery. In our study we tested this hypothesis in patients with preoperative renal function impairment undergoing TAVI (technique requiring contrast media). The results show that in our
ammadex and neostigmine administration to 90% recovery of the TOF ratio was recorded. Results. The two groups demonstrated similar demographic characteristics and none of the patients needed ventilatory assistance during the postoperative period. Both agents proved equally efficient in reversing NMB although a significant difference was recorded between the two groups. The mean time for 90% recovery of the TOF ratio after neostigmine administration was 9.7 min while that of sugammadex did not exceed 2.8 min (P⬍0.05).
S23
Discussion. Sugammadex seems to be superior to neostigmine as a reversal agent of rocuronium-induced intense NMB leading to a more rapid reappearance of normal muscle activity in these patients with their highly increased sensitivity to non-depolarizing neuromuscular blocking drugs [1]. REFERENCE 1. Briggs ED, Kirsch JR. Anesthetic implications of neuromuscular disease. J Anesth 2003; 17: 177-85.
Oral Session IX – Cardiac Anaesthesia O-53 Transcranial Doppler microembolic signals and serum S100 during transcatheter aortic valve implantation Björn Reinsfelt, Anne Westerlind, Dan Ioanes, Henrik Zetterberg, Sven-Erik Ricksten Sahlgrenska University Hospital, Gothenburg, Sweden Introduction. Transcatheter aortic valve implantation (TAVI) is an alternative treatment of aortic stenosis in high-risk patients rejected for an open valve procedure. TAVI induces mechanical stress to the aorta and aortic valve by catheter manipulation, balloon dilatation and valve insertion. Concerns regarding risk of cerebral embolization have been raised [1]. We assessed the impact of TAVI on the cerebral microembolic load by transcranial Doppler (TCD) and on the release of S100 in serum, an established marker of injury to astroglial cells. We hypothesized that the TAVI procedure causes a microembolic load that correlates to CNS injury as assessed by release of S-100. Method. Eleven patients treated with TAVI (CoreValve®) were included. The right medial cerebral artery was insonated using power M-mode TCD. Two physicians independently evaluated the TCD files and identified true microembolic signals. Blood sampling for S100 was performed before the procedure and at 1, 2, 4, 6, 12, and 24 hrs after balloon dilatation of the native valve. Area under the curve (AUC) relating time to S100 concentration was correlated to the embolic load (Spearman correlation).
Results. Mean embolic load was 288 ⫾ 43. All patients had a peak increase of S100 (177⫾26%) within the first hour after
balloon dilatation (fig). Embolic load correlated positively to 24 hr AUC for S100 (r⫽0.697, P⬍0.05). Discussion. We have shown that TAVI induces substantial cerebral microembolization causing CNS cell injury, which is directly correlated to the degree of microembolization. Efforts should be made to limit the cerebral embolic load during TAVI. REFERENCE 1. Dittrich R, Ringelstein EB. Occurrence and clinical impact of microembolic signals during or after cardiosurgical procedures. Stroke 2008; 39: 503-11. O-54 N-acetylcysteine for prevention of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) Glauco Juliano, Claudio Brambillasca, Sebastiana Gregu, Stefano Salis
Guido
Merli,
Centro Cardiologico IRCCS Monzino, Milano, Italy Introduction. N-acetylcysteine (NAC) has been proposed to prevent both contrast-induced nephropathy and acute kidney injury (AKI) with controversial results after cardiac surgery. The aim of the study was to assess the effect of NAC in preventing AKI in patients with preoperative impaired renal function undergoing TAVI. Method. We enrolled 135 patients with preoperative renal function impairment (creatinine clearance ⬍60 ml/min) undergoing TAVI. Patients were randomized to receive NAC (n⫽61) or to be a control group (n⫽74). Patients of the NAC group received NAC (1200 mg iv. every 8 hours starting immediately before surgery). Further worsening of renal function was considered according AKIN classification. Results were analysed with t-test or 2 - test when required. P⬍0.05 was considered significant. The sample size was adequate for ␣ 0.05, with a power of the study ⬎80% Results. No differences were found between the two groups in the main preoperative data: age (P⫽0.95), sex distribution (P⫽0.20), weight (P⫽0.35), EuroSCORE (P⫽0.06), creatinine (P⫽0.11), creatinine clearance (P⫽0.95), echocardiographic left ventricle ejection fraction (P⫽0.70), pressure gradient through aortic valve (P⫽0.56). Nine patients in the control group (12%) and nine in the NAC group (14%) developed postoperative AKI, with no significant difference (P⫽0.65). Three patients with AKI in the control group (4%) and four in the NAC group (6%) required renal replacement treatment, with no significant differences (P⫽0.51). Discussion. Previous papers proposed N-acetylcysteine to prevent contrast-induced nephropathy or AKI after cardiac surgery. In our study we tested this hypothesis in patients with preoperative renal function impairment undergoing TAVI (technique requiring contrast media). The results show that in our