PREVENTION OF CEREBRAL EMBOLISM DURING MITRAL COMMISSUROTOMY: RESULTS IN 433 CONSECUTIVE CASES

Publisher Website
Google Scholar
Abstract
The occurrence of cerebral embolism during mitral valvular surgery with its attendant mortality and morbidity was reduced by occlusion of the left common carotid and innominate arteries at intervals during cardiac manipulation. An umbilical tape is used for the left common carotid artery and another for the innominate artery together with a Rumel tourniquet. The vessels are occluded for periods of 1 minute or less at any time the left atrial appendage is manipulated or sutured, or the finger is inserted into the left atrial chamber or removed, also at any time operative procedure is applied to the valve or during manipulation when atrial thrombi or calcification of the mitral valve is present. Following occlusion, the vessels are allowed to remain open for an equivalent period of time or usually longer to re-establish cerebral circulation. 235 consecutively operated patients were studied for the incidence of embolization prior to the institution of this protective technique and it was found that the incidence was 5.1%, while the incidence of cerebral embolization was 1.8% among 433 consecutively operated cases with the use of this cerebral protection. The incidence of embolization to the lower extremities was increased somewhat in the group where protection was applied, as expected.