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Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary
Ke Yuhe1, Sophia Tsong Huey Chew2, An Shing Ang3
1Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5, Singapore.
Insights
The miniaturized cardiopulmonary bypass (MCPB) system did not reduce postoperative cognitive decline (POCD) after coronary artery bypass grafting (CABG). Risk factors for POCD included lower education and hematocrit levels.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Critical Care Medicine
Background:
- Neurocognitive dysfunction is a frequent complication following coronary artery bypass grafting (CABG), affecting 19-38% of patients.
- The miniaturized cardiopulmonary bypass (MCPB) system was developed to potentially improve cerebral protection compared to conventional cardiopulmonary bypass (CCPB).
- While MCPB has shown promise in reducing stroke incidence, its impact on postoperative cognitive decline (POCD) remains unclear.
Purpose of the Study:
- To evaluate whether the MCPB system reduces the incidence of POCD after CABG.
- To compare the risk factors associated with POCD between MCPB and CCPB groups.
Main Methods:
- A prospective, single-blinded, randomized controlled trial involving 71 Asian patients undergoing elective CABG.
- Patients were randomized to either MCPB (n=36) or CCPB (n=35) groups.
- Neurocognitive function was assessed using the Repeatable Battery of Neuropsychological Status (RBANS), alongside measurements of inflammatory markers, hematocrit, and neuron-specific enolase (NSE).
Main Results:
- The overall incidence of POCD at 3 months was 50% and did not significantly differ between the MCPB and CCPB groups (51.4% vs. 50.0%, P=0.90).
- Lower formal education (<6 years) was a significant risk factor for POCD in the CCPB group (RR=3.014).
- The lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR=0.931).
Conclusions:
- The MCPB system, when used with cell salvage and biocompatible tubing, demonstrated no superiority over CCPB in preventing POCD as measured by RBANS.
- Risk factors for POCD include educational attainment and intraoperative hematocrit levels, highlighting potential targets for intervention.
Background:
Neurocognitive dysfunction is a common complication of coronary artery bypass grafting (CABG) with incidence of 19-38%. The miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce hemodilution and inflammation and provides better cerebral protection than conventional cardiopulmonary bypass (CCPB). In a meta-analysis, MCPB was associated with a 10-fold reduction in the incidence of strokes. However, its effect on postoperative cognitive decline (POCD) is unknown. We assessed if MCPB decreases POCD after CABG and compared the risk factors.
Methods:
A total of 71 Asian patients presenting for elective CABG at a tertiary center were enrolled. They were randomly assigned to MCPB (n = 36) or CCPB group (n = 35) and followed up in a single-blinded, prospective, randomized controlled trial. The primary outcome was POCD as measured by the repeatable battery of neuropsychological status (RBANS). Inflammatory markers (tumor necrosis factor-alpha and interleukin-6), hematocrit levels, and neutron-specific enolase (NSE) levels were studied.
Results:
Overall, the incidence of POCD at 3 months was 50%, and this was not significantly different between both groups (51.4 vs 50.0%, P = 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95% confidence interval (CI) = 1.054-8.618, P = 0.040] was significantly associated with POCD in the CCPB group, while the lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR = 0.931, 95% CI = 0.868-0.998, P = 0.044). The postoperative inflammatory markers and NSE levels were similar between the two groups.
Conclusions:
This study shows that the MCPB was not superior to CCPB with cell salvage and biocompatible tubing with regard to the neurocognitive outcomes measured by the RBANS.
