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- Title
Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial.
- Authors
Yuhe, Ke; Huey Chew, Sophia; Ang, An; Ge Ng, Roderica; Boonkiangwong, Nantawan; Liu, Weiling; Hao Toh, Anastasia; Caleb, Michael; Man Ho, Roger; Ti, Lian; Huey Chew, Sophia Tsong; Ang, An Shing; Ge Ng, Roderica Rui; Hao Toh, Anastasia Han; Caleb, Michael George; Man Ho, Roger Chun; Ti, Lian Kah
- Abstract
<bold>Background: </bold>Neurocognitive dysfunction is a common complication of coronary artery bypass grafting (CABG) with incidence of 19-38%. The miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce hemodilution and inflammation and provides better cerebral protection than conventional cardiopulmonary bypass (CCPB). In a meta-analysis, MCPB was associated with a 10-fold reduction in the incidence of strokes. However, its effect on postoperative cognitive decline (POCD) is unknown. We assessed if MCPB decreases POCD after CABG and compared the risk factors.<bold>Methods: </bold>A total of 71 Asian patients presenting for elective CABG at a tertiary center were enrolled. They were randomly assigned to MCPB (n = 36) or CCPB group (n = 35) and followed up in a single-blinded, prospective, randomized controlled trial. The primary outcome was POCD as measured by the repeatable battery of neuropsychological status (RBANS). Inflammatory markers (tumor necrosis factor-alpha and interleukin-6), hematocrit levels, and neutron-specific enolase (NSE) levels were studied.<bold>Results: </bold>Overall, the incidence of POCD at 3 months was 50%, and this was not significantly different between both groups (51.4 vs 50.0%, P = 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95% confidence interval (CI) = 1.054-8.618, P = 0.040] was significantly associated with POCD in the CCPB group, while the lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR = 0.931, 95% CI = 0.868-0.998, P = 0.044). The postoperative inflammatory markers and NSE levels were similar between the two groups.<bold>Conclusions: </bold>This study shows that the MCPB was not superior to CCPB with cell salvage and biocompatible tubing with regard to the neurocognitive outcomes measured by the RBANS.
- Subjects
SINGAPORE; RESEARCH; CORONARY artery bypass; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; RANDOMIZED controlled trials; BLIND experiment
- Publication
Annals of Cardiac Anaesthesia, 2020, Vol 23, Issue 3, p309
- ISSN
0971-9784
- Publication type
journal article
- DOI
10.4103/aca.ACA_192_18