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J Thorac Cardiovasc Surg 1996;112:1036-1045
© 1996 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
Supported by the Garfield Weston Trust and the Sir Jules Thorn Trust.
Received for publication Sept. 11, 1995 Revisions requested Nov. 29, 1995; revisions received April 12, 1996 Accepted for publication May 21, 1996. Address for reprints: Gianni D. Angelini, FRCS, British Heart Foundation Professor of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.
Abstract
The effect of systemic perfusion temperature on postoperative cognitive function was investigated in 96 adult patients undergoing elective coronary revascularization with cardiopulmonary bypass at 28º C, 32º C, or 37º C. Neuropsychologic performance was assessed 1 day before the operation and 6 weeks after the operation. Five tests were adapted from the Wechsler Adult Intelligence Scale and two from the Wechsler Memory Scale. Results: No patients had major neurologic complications. Ninety-three patients completed the five Wechsler Adult Intelligence Scale tests, but only 70 went on to complete the Wechsler Memory Scale tests as well. In these, there was an effect of cardiopulmonary bypass temperature on the number of neuropsychologic tests in which there was a preoperative to postoperative deterioration (p = 0.021), the number with bypass at 37º C being significantly greater than the number with bypass at 32º C (p = 0.015). Subsidiary analyses using a multivariate linear model examined the effect of cardiopulmonary bypass temperature on the magnitude of change, with or without allowing for other possible confounding influences. There was an adverse effect of normothermic (37º C) versus moderately hypothermic (32º C) perfusion—more convincingly displayed in the analyses of all seven scores rather than just the Wechsler Adult Intelligence Scale scores. Further cooling to 28º C conferred no additional benefit in terms of cognitive function. The importance of the deterioration is open to question. (J THORACCARDIOVASCSURG1996;112:1036-45)
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