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Single aortic clamping in coronary artery bypass surgery reduces cerebral embolism and improves neurocognitive
Hrvoje Gasparovic1, Marko Borojevic, Branko Malojcic
1Department of Cardiac Surgery, University Hospital Rebro Zagreb, Zagreb, Croatia.
Insights
Single aortic clamping during coronary artery bypass grafting (CABG) reduces embolic load, leading to fewer early cognitive deficits and better long-term neurocognitive recovery compared to multiple clamping.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Aortic manipulation during coronary artery bypass grafting (CABG) can release embolic material, increasing the risk of adverse neurologic outcomes.
- Different aortic clamping strategies may influence the embolic load and subsequent neurocognitive function.
Purpose of the Study:
- To compare the neurocognitive outcomes and embolic load between single aortic clamping (SC) and multiple aortic clamping (MC) strategies during CABG.
- To evaluate the impact of aortic clamping on cognitive function and its recovery post-CABG.
Main Methods:
- Prospective study of 59 patients undergoing CABG, divided into SC (n=37) and MC (n=22) groups.
- Neurocognitive assessments (AVLT, Color Trails Test A, Grooved Pegboard, MMSE) performed preoperatively, early postoperatively, and at 4-month follow-up.
- Intraoperative transcranial Doppler (TCD) monitoring used to quantify embolic load.
Main Results:
- The SC group had significantly fewer intraoperative embolization signals (270 ± 181 vs 465 ± 160, p < 0.0001).
- Early postoperative neurocognitive function was depressed in both groups, with a greater magnitude of deficit in the MC group (p < 0.05).
- Neurocognition largely recovered by 4-month follow-up in the SC group, while residual deficits were noted in the MC group.
Conclusions:
- A lower embolic burden in the SC group correlates with reduced early cognitive deficits after CABG.
- Single aortic clamping appears to facilitate superior late restoration of neurocognitive function compared to multiple clamping.
Abstract:
Aortic manipulation releases embolic material, thereby enhancing the probability of adverse neurologic outcomes following coronary artery bypass grafting (CABG). We prospectively evaluated 59 patients undergoing CABG. Patients in the single (SC, n = 37) and multiple clamp (MC, n = 22) groups were comparable in relation to age and operative risk (p > 0.05). Neurocognitive evaluation consisted of the Auditory Verbal Learning Test (AVLT), Color Trails Test A, the Grooved Pegboard test and the Mini-Mental State Examination. Data acquisition was performed preoperatively, early postoperatively and at the 4-month follow-up. Intraoperative transcranial Doppler (TCD) monitoring was used to quantify the embolic load in relation to different aortic clamping strategies. Preoperative neurocognitive results were similar between the groups (p > 0.05). The incidence of postoperative delirium was greater in the MC group but this failed to reach statistical significance (23% vs 8%, p = 0.14). SC patients had fewer embolization signals (270 ± 181 vs 465 ± 160, p < 0.0001). Early postoperative neurocognitive results were depressed in comparison to preoperative values in both groups (p < 0.05 for multiple comparisons). The magnitude of this cognitive depression was greater in the MC group (p < 0.05 for multiple comparisons). Preoperative levels of neurocognition were restored at follow-up in the SC group in all tests except the AVLT. A trend towards improvements in neurocognitive performances at follow-up was also observed in the MC group. Residual attention, motor skill and memory deficits were, however, documented with multiple tests. In conclusion, the embolic burden was significantly lower in the SC group. This TCD imaging outcome translated into fewer early cognition deficits and superior late restoration of function.
