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The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 432-437, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Kolkka and M Hilberman
A prospective 6 month study of all patients undergoing cardiac operation
with cardiopulmonary bypass (CPB) was undertaken to determine the incidence
of neurologic and neuropsychological dysfunction following low-flow,
low-pressure CPB. Among 204 patients who underwent cardiac operation with
CPB, there were seven deaths (3.4%), six who developed new motor deficits
(2.9%), and 35 (17.2%) who exhibited some neurologic or neuropsychological
dysfunction at discharge. When compared to the 169 patients with no
evidence of neurlogic or neuropsychological dysfunction at discharge, these
35 were older (65 +/- 10 versus 55 +/- 12 years), had a lower incidence of
coronary artery bypass grafting as the sole surgical procedure (29% versus
55%), a higher mortality rate (11.4% versus 1.8%), and prolonged CPB (140
+/- 45 versus 107 +/- 38 minutes). The mean arterial pressure (MAP) during
CPB was similar in the two groups (51 +/- 7 versus 49 +/- 7 torr), and an
index of time at low pressure, torr x minutes below 50 (TM less than 50),
was also similar in the two groups (589 +/- 591 versus 554 +/- 478 TM less
than 50). The incidence of postoperative neurologic and neuropsychological
complications appears comparable to that in reports from institutions
employing high CPB flow and maintaining high CPB MAP. Our results suggest
that CPB pressure, per se, is not the major determinant of postoperative
neurologic and neuropsychological dysfunction.
ARTICLES
Neurologic dysfunction following cardiac operation with low-flow, low- pressure cardiopulmonary bypass
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