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Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist
M A Borger1, C M Peniston, R D Weisel
1Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Insights
Increased perfusionist interventions during coronary artery bypass grafting may lead to cognitive impairment. More interventions correlated with worse scores on neuropsychologic tests, suggesting a link between cerebral microemboli and cognitive deficits.
Area of Science:
- Cardiovascular Surgery
- Neuropsychology
- Medical Engineering
Background:
- Neuropsychologic impairment is a frequent complication following coronary bypass surgery.
- Cerebral microemboli during cardiopulmonary bypass are the primary cause of cognitive deficits post-coronary artery bypass grafting.
- Previous research indicates most cerebral emboli originate from perfusionist interventions, such as air injection into the cardiopulmonary bypass circuit.
Purpose of the Study:
- To investigate the association between the frequency of perfusionist interventions and the risk of postoperative cognitive impairment.
Main Methods:
- Eighty-three patients undergoing elective coronary artery bypass grafting were assessed using neuropsychologic tests preoperatively and 3 months postoperatively.
- Patients were categorized into two groups based on the median number of perfusionist interventions during cardiopulmonary bypass (Group 1: <10 interventions, Group 2: ≥10 interventions).
Main Results:
- Group 2 patients experienced longer cardiopulmonary bypass times.
- Despite controlling for bypass duration, Group 2 patients exhibited significantly lower mean scores on 3 key neuropsychologic tests (Rey Auditory Verbal Learning, Digit Span, Visual Span).
- A trend towards increased neuropsychologic impairment was observed in Group 2 patients 3 months postoperatively.
Conclusions:
- Air introduction into the cardiopulmonary bypass circuit by perfusionists, leading to cerebral microembolization, is a potential contributor to postoperative cognitive impairment.
- Minimizing perfusionist interventions may be crucial for preserving cognitive function after coronary bypass surgery.
Objective:
Neuropsychologic impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass are the principal cause of cognitive deficits after coronary bypass grafting. We have previously demonstrated that the majority of cerebral emboli occur during perfusionist interventions (ie, during the injection of air into the venous side of the cardiopulmonary bypass circuit). The purpose of this study was to determine whether an increase in perfusionist interventions is associated with an increased risk of postoperative cognitive impairment.
Methods:
Patients undergoing elective coronary artery bypass grafting (n = 83) underwent a battery of neuropsychologic tests preoperatively and 3 months postoperatively. Patients were divided into 2 groups according to the median value of perfusionist interventions during cardiopulmonary bypass. Group 1 patients (n = 42) had fewer than 10 perfusionist interventions, and group 2 patients (n = 41) had 10 or more interventions.
Results:
The 2 groups of patients were similar for all preoperative, intraoperative, and postoperative variables, with the exception of longer cardiopulmonary bypass times in group 2 patients (P <.001). Group 2 patients had lower mean scores on 9 of 10 neuropsychologic tests, with 3 (Rey Auditory Verbal Learning, Digit Span, and Visual Span) being statistically significant. Group 2 patients had worse cognitive test scores, even when controlling for increased bypass times. Group 2 patients had a nonsignificant trend toward an increased prevalence of neuropsychologic impairment 3 months postoperatively.
Conclusions:
Introduction of air into the cardiopulmonary bypass circuit by perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment.
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