This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Liu, Y.-H. Articles by Sun, W. PubMed Articles by Liu, Y.-H. Articles by Sun, W. Related Collections Cardiovascular Mechanisms Complications Patient Safety

---

CARDIOVASCULAR ANESTHESIOLOGY

The Effects of Cardiopulmonary Bypass on the Number of Cerebral Microemboli and the Incidence of Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery

Ying-Hua Liu, MD^*, Dong-Xin Wang, MD, PhD^*, Li-Huan Li, MD, PhD, Xin-Min Wu, MD^*, Guo-Jin Shan, MD^*, Yu Su, MD^*, Jun Li, MD^*, Qin-Jun Yu, MD, Chun-Xia Shi, MD, Yi-Ning Huang, MD, and Wei Sun, MD

From the *Department of Anesthesiology, Peking University First Hospital, Beijing, China; Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Neurology, Peking University First Hospital, Beijing, China.

Address correspondence and reprints requests to Dong-Xin Wang, MD, PhD, Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku St., Beijing 100034, China. Address e-mail to wangdongxin{at}hotmail.com.

Abstract

BACKGROUND: Postoperative cognitive dysfunction (POCD) can be a debilitating complication after coronary artery bypass graft (CABG) surgery. Cerebral microemboli during cardiopulmonary bypass (CPB) are believed to be an important etiologic factor of POCD. In this study, we examined whether avoidance of CPB with "off-pump" surgery reduces the number of cerebral microemboli and the incidence of POCD after CABG surgery in Chinese population.

METHODS: Two hundred twenty-seven patients were enrolled in this prospective cohort study. Fifty-nine patients underwent CABG surgery with CPB and 168 underwent off-pump surgery. Cerebral microemboli were measured continuously with bilateral transcranial Doppler ultrasonography of the middle cerebral arteries. A neuropsychological test battery that included seven tests with nine subscales was administered at baseline, as well as at 1 wk and 3 mo after surgery. POCD was defined using the international study of POCD1 definition.

RESULTS: The median total number of cerebral microemboli for the case was 430 (range: 155–2088) in patients undergoing surgery with CPB and 2 (0–66) in the off-pump patients (P < 0.001). There were no differences in the incidence of POCD between the patients having surgery with or without CPB either at 1 wk (55.2% or 32 of 58 patients [95% confidence interval: 41.5%–68.3%] vs 47.0% or 78 of 166 patients [39.2%–54.9%], P = 0.283) or 3 mo (6.4% or 3 of 47 patients [1.3%–17.5%] vs 13.1% or 16 of 122 of patients [7.7%–20.4%], P = 0.214) after surgery. Increasing age and shorter duration of postoperative hospital stay were independently associated with cognitive dysfunction at 1 wk after surgery. Increasing age and a history of diabetes mellitus were independently associated with cognitive dysfunction 3 mo after surgery. CPB or cerebral microemboli were not significantly related to the occurrence of POCD.

CONCLUSIONS: In Chinese population, avoidance of CPB during CABG surgery significantly decreased the number of cerebral microemboli, but it did not decrease the incidence of POCD at either 1 wk or 3 mo after CABG. Neither CPB nor cerebral microemboli was independently associated with the risk of POCD.

This article has been cited by other articles:

				D. van Dijk and C. J. Kalkman Why Are Cerebral Microemboli Not Associated with Cognitive Decline? Anesth. Analg., October 1, 2009; 109(4): 1006 - 1008. [Full Text] [PDF]