Cerebral injury during cardiopulmonary bypass: Emboli impair memory

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 121; no. 6; pp. 1150 - 1160
• Main Authors: Fearn, S.J., Pole, R., Wesnes, K., Faragher, E.B., Hooper, T.L., McCollum, C.N.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-06-2001; AATS/WTSA; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Cognition Disorders - diagnosis; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Disease - surgery; Female; Follow-Up Studies; Humans; Incidence; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - epidemiology; Intracranial Embolism - etiology; Male; Medical sciences; Memory Disorders - diagnosis; Memory Disorders - epidemiology; Memory Disorders - etiology; Middle Aged; Neurologic Examination; Postoperative Period; Preoperative Care; Probability; Reference Values; Risk Factors; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Treatment Outcome; Ultrasonography, Doppler; Vascular disease; Cardiopulmonary bypass; Human; Nervous system diseases; Central nervous system disease; Cerebral embolism; Anesthesia; Cardiovascular disease; Complication; Cognition; Cerebrovascular disease; Cerebral disorder
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2001.114099

Objectives: Cognitive deficits occur in up to 80% of patients after cardiac surgery. We investigated the influence of cerebral perfusion and embolization during cardiopulmonary bypass on cognitive function and recovery. Methods: Cerebrovascular reactivity was measured in 70 patients before coronary operations in which nonpulsatile bypass was used. Throughout the operations, middle cerebral artery flow velocity and embolization were recorded by transcranial Doppler and regional oxygen saturation was recorded by near-infrared spectroscopy. Cognitive function was measured by a computerized battery of tests before the operation and 1 week, 2 months, and 6 months after surgery. Elderly patients undergoing urologic surgery served as controls. Results: Cerebrovascular reactivity was impaired preoperatively in 49 patients. Median (interquartile range) regional cerebral oxygen saturation fell during bypass by 10% (6%-15%), indicating increased oxygen extraction, whereas mean middle cerebral flow velocity increased significantly by a median of 6 cm/s (both P <.0001, Wilcoxon), suggesting increased arterial tone. More than 200 emboli were detected in 40 patients, mainly on aortic clamping and release, when bypass was initiated, and during defibrillation. Cognitive function deteriorated more in patients having cardiopulmonary bypass than in control patients having urologic operations but recovered in most tests by 2 months. Measures of cerebral perfusion (poor cerebrovascular reactivity, low arterial pressures, and flow velocity in the middle cerebral artery) predicted poor attention at 1 week (r = 0.3, P <.01, Spearman). Emboli were associated with memory loss (r = 0.3, P <.02, Spearman). Conclusions: Cognitive deficits were common after cardiopulmonary bypass. Occult cerebrovascular disease was more severe than expected and predisposed to attention difficulties, whereas emboli caused memory deficits. We believe this to be the first report of differing cognitive effects from emboli and hypoperfusion. (J Thorac Cardiovasc Surg 2001;121:1150-60)