Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study

Abstract

The study is registered at ClinicalTrials.gov, number NCT01213511.

The impact of S100b and persistent high levels of neuron-specific enolase on cognitive performance in elderly patients after cardiopulmonary bypass

“…R.) diagnosed delirium every day in the morning from the operative day to postoperative day 8 using the Delirium-Rating-Scale (DRS) by Trzepacz et al [31]. Impairments in immediate recall and in short-term memory during a state of delirium are widely documented [4][5][6][7][8][9][10]. The long-term memory remains intact in most of the cases.…”

“…coronary artery bypass graft [CABG], valvular surgery) have increased greatly over the past few decades [1,2]. However, minor neuropsychological impairments after cardiac surgery are widely documented [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. For example, Newman et al [7] found a post-operative cognitive decline in 53% patients at discharge, 36% at 6 weeks after surgery and 24% at 6 months.…”

Almanac 2013-stable coronary artery disease

“…This may reflect, at least in part, differences in graft patency rates favouring on-pump procedures, the ROOBY trial reporting rates of 91.4% vs. 85.8% for arterial grafts and 80.4% vs. 72.7% for saphenous vein grafts in on-pump compared with off-pump patients (63). Particularly disappointing has been the failure of off-pump surgery to reduce cerebral injury, but a randomised comparison of minimal (MECC) versus conventional (CECC) extracorporeal circulation in 64 patients undergoing CABG has been more promising (64). MECC was associated with improved cerebral oxygen delivery during surgery, and neurocognitive performance at 3 months was better when compared with CECC.…”

30-day mortality reduction with miniaturized extracorporeal circulation as compared to conventional cardiopulmonary bypass for coronary revascularization. Meta-analysis of randomized controlled trials

“…It confirms, in a comprehensive fashion, the notion that restricting CPB exposure, whether it means the X-clamp duration, length of tubing systems, air-blood contact surface or the microemboli count, may indeed improve short-term survival. From initial experience, MECC was demonstrated to be safe, feasible and superior to CECC in terms of postoperative complications; numerous studies report reduced need for transfusions due to lower hemodilution, less myocardial damage as evidenced by diminished release of CK-MB and positive impact on postoperative neurocognitive outcome as compared to standard CPB [3][4][5]. None of the single RCTs was capable though of detecting any difference in hard clinical outcomes; none of the three previously published meta-analyses were able to detect difference in mortality between these two techniques as well, most probably due to small sample sizes of individual studies included.…”