Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial.

To compare intraoperative cerebral microembolic load between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) during isolated surgical aortic valve replacement (SAVR), we conducted a randomized trial in patients undergoing primary elective SAVR at a tertiary referral hospital. The primary outcome was the procedural phase-related rate of high-intensity transient signals (HITS) on transcranial Doppler ultrasound. HITS rate was used as a surrogate of cerebral microembolism in pre-defined procedural phases in SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with integrated arterial filter. Forty-eight patients were randomized in a 1:1 ratio to MiECC or CECC. Due to intraprocedural Doppler signal loss (n = 3), 45 patients were included in final analysis. MiECC perfusion regimen showed a significantly increased HITS rate compared to CECC (by a factor of 1.75; 95% confidence interval, 1.19-2.56). This was due to different HITS rates in procedural phases from aortic cross-clamping until declamping [phase 4] (P = 0.01), and from aortic declamping until stop of extracorporeal perfusion [phase 5] (P = 0.05). Post hoc analysis revealed that MiECC-F generated a higher HITS rate than CECC+F (P = 0.005), CECC-F (P = 0.05) in phase 4, and CECC-F (P = 0.03) in phase 5, respectively. In open-heart surgery, MiECC is not superior to CECC with regard to gaseous cerebral microembolism. When using MiECC for SAVR, the use of oxygenators with integrated arterial line filter appears highly advisable. Only with this precaution, MiECC confers a cerebral microembolic load comparable to CECC during this type of open heart surgery.

(Table T1) Strontium isotopic composition and ages of limestone samples from ODP Hole 180-1118A

Limestone from Unit VI (857.1-859.15 meters below seafloor) collected at Site 1118 contains a planktonic foraminiferal fauna indicating a latest Miocene to early Pliocene age. Globorotalia tumida is recorded in Sample 180-1118A-68R-4, 46-48 cm, indicating an early Pliocene (N18) age at this level (J. Resig, pers. comm., 2000). Based on their known range in the western Papuan Basin, the presence of (rare) Lepidocyclina and common Amphistegina in some samples suggests that abundant shallow-water bioclastic debris present in these limestones may be reworked from older, possibly middle or early late Miocene sediments. Four samples were selected for whole-rock strontium isotopic analysis to further investigate this possibility. A petrographic examination of samples analyzed was also conducted.

Streamflow recharge to the Madison Limestone and the Casper Formation in the Glenrock area, east-central Wyoming /

Mode of access: Internet.

Ueber fossile Hydrocorallinen (Stromatorpora und ihre Verwandten) überhaupt mit besonderer Berückscihtigung der in den Unter-Permschichten (Middle Productus-Limestone) der Salt-Range auftretenden Formen. Nebst einem Anhange.

Inaug. Dissert. mat. u. naturw. Kaiser Wil.-Univ.

Body/repair shop visits to determine distribution of replacement parts sources. Final report.

National Highway Traffic Safety Administration, Washington, D.C.