Document Detail


Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery.
MedLine Citation:
PMID:  17923575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with cell saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery. METHODS AND RESULTS: A total of 226 elderly patients were randomly allocated to either cell saver or control groups. Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the cell saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (P=0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups. CONCLUSIONS: The present report demonstrates that processing of shed blood with cell saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass.
Authors:
George Djaiani; Ludwik Fedorko; Michael A Borger; Robin Green; Jo Carroll; Michael Marcon; Jacek Karski
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-08
Journal Detail:
Title:  Circulation     Volume:  116     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-29     Completed Date:  2008-01-29     Revised Date:  2008-06-30    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1888-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada. george.djaiani@uhn.on.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Atherosclerosis / complications,  physiopathology,  surgery
Blood Loss, Surgical / prevention & control*
Blood Transfusion, Autologous* / adverse effects
Cardiopulmonary Bypass* / adverse effects
Cerebrovascular Circulation
Cognition Disorders / etiology,  prevention & control*
Female
Hemofiltration*
Humans
Intracranial Embolism / etiology,  prevention & control*
Male
Middle Aged
Surgical Procedures, Elective
Comments/Corrections
Comment In:
Circulation. 2007 Oct 23;116(17):1879-81   [PMID:  17965403 ]
Circulation. 2008 May 27;117(21):e348; author reply e349   [PMID:  18506013 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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