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Evaluation of coated oxygenators in cardiopulmonary-bypass systems and their impact on neurocognitive function
Amir Khosravi1, Christian A Skrabal, Bernd Westphal
1Department of Cardiac Surgery, University of Rostock, Rostock, Germany.
Insights
Phosphorylcholine (PC) coating on oxygenators did not improve neurocognitive function in patients undergoing coronary artery bypass graft (CABG) surgery. Neurocognitive decline was observed early after CABG, regardless of oxygenator type.
Area of Science:
- Cardiology
- Neurology
- Biomaterials
Background:
- Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) is linked to neurocognitive decline.
- Investigating protective strategies for neurological outcomes is crucial.
Purpose of the Study:
- To analyze neurocognitive function in coronary heart disease patients before and after CABG.
- To evaluate the neuroprotective potential of phosphorylcholine (PC)-coated oxygenators.
Main Methods:
- Prospective randomized study of 40 patients undergoing CABG.
- Comparison of non-coated (Group A) versus PC-coated (Group B) hollow-fibre membrane oxygenators.
- Neurocognitive assessment using six neurological tests at multiple time points.
Main Results:
- One patient in Group A experienced a perioperative stroke and died; two developed delirious psychotic syndrome.
- No perioperative complications were reported in Group B.
- A trend of neurocognitive decline was observed early post-CABG, with no significant difference between groups.
Conclusions:
- Phosphorylcholine coating of oxygenators did not demonstrate a significant benefit in preserving neurocognitive function after CABG.
- Further research may be needed to explore alternative neuroprotective strategies.
Introduction:
Coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB) is assumed to be associated with a decline of neurocognitive functions. This study was designed to analyse the neurocognitive function of patients with coronary heart disease before and after CABG and to determine possible protective effects of oxygenator surface coating on neurological outcome.
Methods:
Forty patients scheduled for selective CABG were prospectively randomized into two groups of 20 patients each according to the type of hollow-fibre membrane oxygenator used. Non-coated oxygenators (Group A) were compared to phosphorylcholine (PC)coated oxygenators (Group B). A battery of six neurological tests was administered preoperatively, 7-10 days and 4-6 months after surgery.
Results:
One patient of Group A suffered from a perioperative stroke and died on postoperative day 3, presumably because of sudden heart failure. Two patients of Group A (10%) developed a symptomatic transitory delirious psychotic syndrome (STPT) on postoperative days 3 and 5. None of the patients of Group B had perioperative complications. The test analysis revealed a trend of declined neurocognitive function early after CABG, but did not show any difference in neurocognitive outcome between the two groups.
Discussion:
PC coating of the oxygenators did not show any significant benefit on neurocognitive function after CABG using CPB.
