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J Thorac Cardiovasc Surg 1998;115:482-483
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: A prospective, randomized trial

Akif Ündar, PhD , Craig M. Helfrich, MD, Scott B. Johnson, MD, John H. Calhoon, MD

To the Editor:

We read with great interest the article by Plourde and associates.Go 1 They have compared the effects of normothermic (n = 30) versus hypothermic (n = 24) cardiopulmonary bypass (CPB) for cognitive outcomes of patients undergoing coronary bypass. Bubble oxygenators were used exclusively in their study. They have noted that "there is no evidence that membrane oxygenators improve cognitive outcome, despite their ability to reduce microembolic events."

It has been clearly shown that cognitive outcomes of patients are strongly associated with the number of emboli that were delivered during cardiac surgery.Go Go 2-5 Stump and associatesGo 2 have discovered that patients with neurologic deficit had twice the number of emboli as those without deficit in a study of 167 patients. If the number of emboli was greater than 100, then the patients had significant neurologic deficit (p  = 0.028). Pugsley and coworkersGo 4 had similar results in a study of 94 patients. When the number of microemboli was less than 200, five of 58 patients (8.6%) demonstrated a neuropsychologic deficit at 8 weeks; microemboli count between 201 and 500, three of 13 patients (23%); microemboli count between 501 and 1000, five of 16 patients (31%); and microemboli count greater than 1000, three of seven patients (43%).

Blauth and associatesGo 6 have discovered that retinal microembolism and neuropsychologic deficit after CPB were more common with a bubble oxygenator than with a membrane oxygenator in a study of 40 patients. All 23 patients (100%) in the bubble oxygenator group had retinal embolism compared with eight of 17 patients (47%) in the membrane oxygenator group (p < 0.001). However, the difference in neuropsychologic deficits was not statistically significant (p = 0.11). In a larger study, Blauth and associatesGo 7 have shown that 30 patients (100%) in the bubble oxygenator group had retinal perfusion defects compared with 15 of 34 patients in the membrane group (p < 0.001).

Several other investigators have documented that the use of membrane oxygenation causes significantly less microembolism than the use of bubble oxygenation during normothermic or hypothermic CPB.Go Go 8-11 We are surprised that the use of bubble oxygenators is still dictated by some institutions.

Cardiothoracic Research Laboratory
Division of Thoracic SurgeryDepartment of SurgeryThe University of Texas Health Science CenterSan Antonio, TX 78284-7841 References

  1. Plourde G, Leduc AS, Morin JE, et al. Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: a prospective, randomized trial. J Thorac Cardiovasc Surg 1997;114:123-8.[Abstract/Free Full Text]
  2. Stump DA, Rogers AT, Hammon JW, Newman SP. Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothorac Vasc Anesth 1996;10:113-9.[Medline]
  3. Stump DA, Tegeler CH, Rogers AT, et al. Neuropsychological deficits are associated with the number of emboli detected during cardiac surgery. Stroke 1993;24:509.
  4. Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke 1994;25:1393-9.[Abstract]
  5. Pugsley W, Klinger L, Paschalis C, Aspey B, Newman S, Harrison M. Microemboli and cerebral impairment during cardiac surgery. Vasc Surg 1990;24:34-43.
  6. Blauth C, Smith P, Newman S, et al. Retinal microembolism and neuropsychological deficit following clinical cardiopulmonary bypass: comparison of a membrane and a bubble oxygenator—a preliminary communication. Eur J Cardiothorac Surg 1989;3:135-9.[Abstract]
  7. Blauth CI, Smith PL, Arnold JV, Jagoe JR, Wootton R, Taylor KM. Influence of oxygenator type on the prevalence and extent of microembolic retinal ischemia during cardiopulmonary bypass. J  Thorac Cardiovasc Surg 1990;99:61-9.[Abstract]
  8. Padayachee TS, Parsons S, Theobold R, Linley J, Gosling RG, Deverall PB. The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators. Ann Thorac Surg 1987;44:298-302.[Abstract]
  9. Johnston WE, Stump DA, DeWitt DS, et al. Significance of gaseous microemboli in the cerebral circulation during cardiopulmonary bypass in dogs. Circulation 1993;88(Pt 2):319-29.[Free Full Text]
  10. Deverall PB, Padayachee TS, Parsons S, Theobald R, Batistessa SA. Ultrasound detection of microemboli in the middle cerebral artery during cardiopulmonary bypass surgery. Eur J Cardiothorac Surg 1988;2:256-60.[Abstract]
  11. Pearson DT, Holden MP, Poslad SJ, Murray A, Waterhouse PS. A clinical evaluation of the performance characteristics of one membrane and five bubble oxygenators: gas transfer and gaseous microemboli production. Perfusion 1986;1:15-26.



This article has been cited by other articles:


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M. W Hall, R. O Hopkins, J. W Long, S F. Mohammad, and K. A Solen
Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study
Perfusion, May 1, 2005; 20(3): 157 - 167.
[Abstract] [PDF]

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