Lower Perfusion Pressure during Hypothermic Cardiopulmonary Bypass Is Associated with Decreased Cerebral Blood Flow and Impaired Memory Performance 6 Months Postoperatively

Authors

  • Adolfo Paolin
  • Paolo Michielon
  • Michele Betetto
  • Giuseppe Sartori
  • Carlo Valfré
  • Guido Rodriguez
  • John M. Murkin

DOI:

https://doi.org/10.1532/HSF98.20091122

Abstract

Objectives: We undertook to determine the influence of perfusion pressure during hypothermic cardiopulmonary bypass (CPB) on cerebral blood flow (CBF) and cognitive memory outcome at 6 months postoperatively.

Methods: Nineteen patients who underwent hypothermic nonpulsatile CPB for elective coronary artery bypass (CAB) surgery were evaluated by 133Xe measurement of the CBF and by the Incidental Memory Assessment for evaluating cognitive memory (IMTscore), both at baseline before the operation (T1) and again at 5 to 6 months postoperatively (T2).

Results: Overall, the mean CBF fell significantly from 39 ± 5 mL·(100 g)-1·min-1 at T1 to 33 ± 3 mL·(100 g)-1·min-1 at T2 (P < .001). The decrease in CBF from T1 to T2 (?CBF2-1) correlated with a significant reduction in the IMTscore from T1 to T2 (?IMTscore2-1) (P < .001) and with a mean arterial pressure during CPB (MAPCPB) of <60 mm Hg (P = .05). Cluster analysis of ?CBF2-1 and ?IMTscore2-1 demonstrated that the patients with the greatest decrease in CBF showed the greatest decrease in IMTscore, whereas cluster analysis of ?CBF2-1 and MAPCPB indicated that patients with a perfusion pressure maintained at a mean of <60 mm Hg during CPB were prone to a greater decrease in later postoperative CBF.

Conclusion: This study demonstrated that a MAPCPB of <60 mm Hg during CPB was associated with a significant decrease in CBF 6 months after CAB surgery and with an associated decrease in memory performance.

References

Bokeriia LA, Golukhova EZ, Polunina AG. 2009. Postoperative delirium in cardiac operations: microembolic load is an important factor. Ann Thorac Surg 88:349-50.nChernov VI, Efimova NY, Efimova IY, Akhmedov SD, Lishmanov YB. 2006. Short-term and long-term cognitive function and cerebral perfusion in off-pump and on-pump coronary artery bypass patients. Eur J Cardiothorac Surg 29:74-81.nChock VY, Amir G, Davis CR, et al. 2006. Antegrade cerebral perfusion reduces apoptotic neuronal injury in a neonatal piglet model of cardiopulmonary bypass. J Thorac Cardiovasc Surg 131:659-65.nD'Ancona G, Saez de Ibarra JI, Baillot R, et al. 2003. Determinants of stroke after coronary artery bypass grafting. Eur J Cardiothorac Surg 24:552-6.nden Uil CA, Lagrand WK, Spronk PE, et al. 2008. Impaired sublingual microvascular perfusion during surgery with cardiopulmonary bypass: a pilot study. J Thorac Cardiovasc Surg 136:129-34.nGerriets T, Schwarz N, Sammer G, et al. 2009. Protecting the brain from gaseous and solid micro-emboli during coronary artery bypass grafting: a randomized controlled trial. Eur Heart J. In press.nGold JP, Charlson ME, Williams-Russo P, et al. 1995. Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 110:1302-14.nHenriksen L. 1984. Evidence suggestive of diffuse brain damage following cardiac operations. Lancet 1:816-20.nKnipp SC, Matatko N, Wilhelm H, et al. 2008. Cognitive outcomes three years after coronary artery bypass surgery: relation to diffusion-weighted magnetic resonance imaging. Ann Thorac Surg 85:872-9.nMeyers CA, Weitzner M, Byrne K, Valentine A, Champlin RE, Przepiorka D. 1994. Evaluation of the neurobehavioral functioning of patients before, during, and after bone marrow transplantation. J Clin Oncol 1994:12:820-36.nMurkin JM. 2006. Pathophysiological basis of CNS injury in cardiac surgical patients: detection and prevention. Perfusion 21:203-8.nMurkin JM, Farrar JK, Tweed WA, McKenzie FN, Guiraudon G. 1987. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2. Anesth Analg 66:825-32.nMurkin JM, Martzke JS, Buchan AM, Bentley C, Wong CJ. 1995. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 110:349-62.nNewman MF, Croughwell ND, Blumenthal JA, et al. 1994. Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction. Circulation 90:II243-9.nNewman MF, Kirchner JL, Phillips-Bute B, et al., for the Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. 2001. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 344:395-402.nNishimura T, Fukuchi K, Hayashida K, Hirose Y, Iwamoto B. 1998. Decreased hippocampal blood flow related to memory impairment after cardiovascular surgery: assessment by reconstructed SPECT parallel to the longitudinal axis of the hippocampal formations. Clin Nucl Med 23:356-60.nPloch W, Cook DJ, Orszulak TA, Daly RC. 1998. Critical cerebral perfusion pressure during tepid heart operation in dogs. Ann Thorac Surg 66:118-23.nSato Y, Laskowitz DT, Bennett ER, Newman MF, Warner DS, Grocott HP. 2002. Differential cerebral gene expression during cardiopulmonary bypass in the rat: evidence for apoptosis? Anesth Analg 94:1389-94.nSchwartz AE, Sandhu AA, Kaplon RJ, et al. 1995. Cerebral blood flow is determined by arterial pressure and not cardiopulmonary bypass flow rate. Ann Thorac Surg 60:165-9.nSelnes OA, Grega MA, Bailey MM, et al. 2007. Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study. Ann Thorac Surg 84:1885-96.nShann KG, Likosky DS, Murkin JM, et al. 2006. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg 132:283-90.nTreasure T, Smith PLC, Newman S, et al. 1989. Impairment of cerebral function following cardiac and other major surgery. Eur J Cardiothorac Surg 3:216-21.n

Published

2010-02-11

How to Cite

Paolin, A., Michielon, P., Betetto, M., Sartori, G., Valfré, C., Rodriguez, G., & Murkin, J. M. (2010). Lower Perfusion Pressure during Hypothermic Cardiopulmonary Bypass Is Associated with Decreased Cerebral Blood Flow and Impaired Memory Performance 6 Months Postoperatively. The Heart Surgery Forum, 13(1), E7-E12. https://doi.org/10.1532/HSF98.20091122

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