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J Thorac Cardiovasc Surg 1995;110:349-362
© 1995 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
London and Ottawa, Ontario, and Vancouver, British Columbia, Canada
Supported by grant A1498 from the Heart and Stroke Foundation of Ontario.
Presented in part at the Fiftieth Annual Meeting of the Canadian Anaesthetists Society, Halifax, Nova Scotia, Canada, June 1993.
Received for publication Sept. 1, 1994. Accepted for publication Dec. 22, 1994. Address for reprints: John M. Murkin, MD, Department of Anaesthesia, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5
Abstract
This double-blind, randomized comparison of pulsatile or nonpulsatile perfusion and alpha-stat or pH-stat management during cardiopulmonary bypass was designed to assess postoperative central nervous system outcomes. Methods: Neurologic and cognitive testing was conducted before the operation and 7 days and 2 months after the operation in 316 patients having coronary artery bypass and in a reference cohort of 40 patients having major vascular and thoracic operations. Results: As detailed in part I of this study, mortality in patients having coronary bypass was 2.8%. The incidence of stroke was 2.5% and did not differ among bypass groups. Mortality was 2.5% for the major surgery cohort. The incidence of cognitive (p = 0.003) and either neurologic or cognitive dysfunction (p = 0.0002) was higher at 7 days for the coronary bypass group than for the major surgery cohort. The incidence of neurologic dysfunction remained higher (p = 0.050) at 2 months in the coronary bypass group. Cognitive dysfunction at 2 months was less prevalent after 90 minutes of cardiopulmonary bypass in patients managed with alpha-stat than with pH-stat strategy (27% versus 44%, p = 0.047). Conclusions: Postoperative central nervous system dysfunction is more prevalent in patients having coronary bypass than in those having major operations. Pulsatility has no effect on central nervous system outcomes, but alpha-stat management is associated with a decreased incidence of cognitive dysfunction in patients undergoing prolonged cardiopulmonary bypass. (J THORAC CARDIOVASC SURG 1995;110:349-62)
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