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J Thorac Cardiovasc Surg 2001;121:743-749
© 2001 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology |
From the Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Supported in part by the Heart and Stroke Foundation of Ontario, grant NA-3484. M.A.B. is a Research Fellow of the HSFO. R.D.W. is a Career Investigator of the HSFO.
Received for publication April 5, 2000. Revisions requested July 27, 2000; revisions received Aug 17, 2000. Accepted for publication Oct 24, 2000. Address for reprints: Christopher M. Feindel, MD, Division of Cardiovascular Surgery, The Toronto Hospital, Room EN 14-222, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4.
Abstract
Objective: Neuropsychologic impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass are the principal cause of cognitive deficits after coronary bypass grafting. We have previously demonstrated that the majority of cerebral emboli occur during perfusionist interventions (ie, during the injection of air into the venous side of the cardiopulmonary bypass circuit). The purpose of this study was to determine whether an increase in perfusionist interventions is associated with an increased risk of postoperative cognitive impairment.
Methods: Patients undergoing elective coronary artery bypass grafting (n = 83) underwent a battery of neuropsychologic tests preoperatively and 3 months postoperatively. Patients were divided into 2 groups according to the median value of perfusionist interventions during cardiopulmonary bypass. Group 1 patients (n = 42) had fewer than 10 perfusionist interventions, and group 2 patients (n = 41) had 10 or more interventions.
Results: The 2 groups of patients were similar for all preoperative, intraoperative, and postoperative variables, with the exception of longer cardiopulmonary bypass times in group 2 patients (P < .001). Group 2 patients had lower mean scores on 9 of 10 neuropsychologic tests, with 3 (Rey Auditory Verbal Learning, Digit Span, and Visual Span) being statistically significant. Group 2 patients had worse cognitive test scores, even when controlling for increased bypass times. Group 2 patients had a nonsignificant trend toward an increased prevalence of neuropsychologic impairment 3 months postoperatively.
Conclusions: Introduction of air into the cardiopulmonary bypass circuit by perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment.
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