Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 309--314

Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial


Ke Yuhe1, Sophia Tsong Huey Chew2, An Shing Ang3, Roderica Rui Ge Ng4, Nantawan Boonkiangwong5, Weiling Liu6, Anastasia Han Hao Toh7, Michael George Caleb4, Roger Chun Man Ho8, Lian Kah Ti6 
1 Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5, Singapore
2 Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5; Department of Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore
3 Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore
4 Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5; Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore
5 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, Singapore
6 Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of Anesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore
7 Department of Psychological Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore
8 Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of Psychological Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore

Correspondence Address:
Lian Kah Ti
Department of Anesthesia, National University Health System,5 Lower Kent Ridge Road, 119074
Singapore

Background: 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. Methods: 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. Results: 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. Conclusions: 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.


How to cite this article:
Yuhe K, Huey Chew ST, Ang AS, Ge Ng RR, Boonkiangwong N, Liu W, Hao Toh AH, Caleb MG, Man Ho RC, Ti LK. Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial.Ann Card Anaesth 2020;23:309-314


How to cite this URL:
Yuhe K, Huey Chew ST, Ang AS, Ge Ng RR, Boonkiangwong N, Liu W, Hao Toh AH, Caleb MG, Man Ho RC, Ti LK. Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial. Ann Card Anaesth [serial online] 2020 [cited 2021 Aug 2 ];23:309-314
Available from: https://www.annals.in/article.asp?issn=0971-9784;year=2020;volume=23;issue=3;spage=309;epage=314;aulast=Yuhe;type=0