Determination of Neurocognitive Changes Using Electroencephalography and the Mini-Mental Test in Coronary Bypass Patients Who Underwent Operation with Pulsatile and Non-Pulsatile Cardiopulmonary Bypass

Abstract Purpose Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Methods A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months. Results The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner—when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories. Conclusions Off-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.

Download Full-text

Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

Perfusion ◽

10.1177/0267659118793249 ◽

2018 ◽

Vol 34 (2) ◽

pp. 130-135 ◽

Cited By ~ 4

Author(s):

Gunnar Malmqvist ◽

Helena Claesson Lingehall ◽

Micael Appelblad ◽

Staffan Svenmarker

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Prospective Observational Study ◽

Hospital Setting ◽

Plasma Osmolality ◽

Coronary Bypass ◽

University Hospital ◽

Organ Function ◽

Rapid Changes ◽

Relationship Of

Introduction: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime. Method: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used. Results: Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg). Conclusions: Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1

Download Full-text

Invalid Determination of Renal Blood Flow During Hypothermic Cardiopulmonary Bypass

Anesthesia & Analgesia ◽

10.1097/00000539-199605000-00059 ◽

1996 ◽

Vol 82 (5) ◽

pp. 1112 ◽

Cited By ~ 1

Author(s):

Guillermo Lema ◽

Jorge Urzua ◽

Roberto Canessa

Keyword(s):

Blood Flow ◽

Cardiopulmonary Bypass ◽

Renal Blood Flow ◽

Hypothermic Cardiopulmonary Bypass

Download Full-text

Heparin-coated Cardiopulmonary Bypass Circuits in Coronary Bypass Surgery

Artificial Organs ◽

10.1111/j.1525-1594.1996.tb04573.x ◽

1996 ◽

Vol 20 (8) ◽

pp. 936-940 ◽

Cited By ~ 10

Author(s):

Hitoshi Horimoto ◽

Keiichiro Kondo ◽

Kunio Asada ◽

Shinjiro Sasaki

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery

Download Full-text

Surgical Steps toward Complete Revascularization in Off-Pump Coronary Bypass

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000302 ◽

2002 ◽

Vol 10 (3) ◽

pp. 201-205 ◽

Cited By ~ 2

Author(s):

Kit V Arom ◽

Robert W Emery ◽

Thomas F Flavin ◽

Vibhu R Kshettry ◽

Patricia Janey

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Revascularization ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Surgical Techniques ◽

Coronary Bypass ◽

Patient Characteristics ◽

Complete Revascularization ◽

Anesthetic Techniques ◽

Off Pump

Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.

Download Full-text

Determination of significant differences in performance of the Bentley BOS-CM 40 hollow fibre membrane oxygenator and the Polystan VT5000 venotherm bubble oxygenator

Perfusion ◽

10.1177/026765918700200408 ◽

1987 ◽

Vol 2 (4) ◽

pp. 289-295 ◽

Cited By ~ 5

Author(s):

Ludwig von Segesser

Keyword(s):

Cardiopulmonary Bypass ◽

Hollow Fibre ◽

Membrane Oxygenator ◽

Mean Flow ◽

Hollow Fibre Membrane ◽

Fibre Membrane ◽

Bubble Oxygenator ◽

Venous Oxygen Saturation ◽

The Difference

Ten mongrel dogs were connected to cardiopulmonary bypass by cavoaortic cannulation, classic roller pump and either Bentley BOS-CM 40 hollow fibre membrane oxygenator or Polystan VT5000 Venotherm bubble oxygenator for eight hours, with mean flow rate of 100 ml/kg min. Platelet counts (all values corrected by prebypass haematocrit) were significantly lower in the bubble oxygenator group after two hours of cardiopulmonary bypass (p < 0·01). Plasma haemoglobin production was significantly higher after two hours of cardiopulmonary bypass in the bubble oxygenator group (p < 0·01). Venous oxygen saturation (SvO2) was above 65% during the eight hours perfusion in the membrane oxygenator group. In the bubble oxygenator group, however, SvO2 was below 60% after six hours of cardiopulmonary bypass. After eight hours perfusion the difference in SvO2 between the two groups was significant (p < 0·05). Thus membrane oxygenators such as the Bentley BOS-CM 40 appear to be indicated in cardiopulmonary bypass of more than two hours duration.

Download Full-text