Pulsatile cardiopulmonary bypass failed to prevent neuropsychological dysfunction.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Medical Imaging

Background:

• Neurological complications are a risk during cardiopulmonary bypass.
• Cerebrovascular screening aims to identify patients at higher risk.
• Pulsatile cardiopulmonary bypass is an alternative perfusion strategy.

Purpose of the Study:

• To evaluate the effectiveness of preoperative cerebrovascular screening and pulsatile cardiopulmonary bypass in preventing neurological complications.
• To assess the incidence of cerebral infarction and neuropsychological dysfunction post-cardiopulmonary bypass.

Main Methods:

• Preoperative magnetic resonance angiography and computed tomographic scans for cerebrovascular screening.
• Stratification of patients into high-risk and control groups based on screening results.
• Application of pulsatile cardiopulmonary bypass in the high-risk group.
• Postoperative assessment for cerebral infarction and neuropsychological changes using Hasegawa's dementia scale.

Main Results:

• Cerebral infarction due to embolism occurred in 1.7% of patients (not statistically significant between groups).
• No cerebral infarctions due to hypoperfusion were observed.
• Postoperative dementia was diagnosed in 7 patients (4.9%), with a higher incidence in the high-risk group (17.1%) compared to the control group (0.9%).

Conclusions:

• Cerebrovascular screening and pulsatile cardiopulmonary bypass did not prevent all neurological complications.
• While hypoperfusion-related cerebral infarction was avoided, embolic events and neuropsychological dysfunction remain concerns.
• Further strategies are needed to mitigate embolic risks and prevent neuropsychological decline after cardiopulmonary bypass.