097 Comparison of the neurocognitive sequelae of Coronary Artery Bypass Grafting (CABG) using conventional (CECC) or minimized extracorporeal circulation (MinECC)

Abstract

BackgroundThe aim of this study was to investigate the course of neurocognitive function in patients who underwent coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) compared to minimized extracorporeal circulation (MinECC) and the surgery and patient-specific factors contributing to cognitive impairment. Given recent reports of reduced hemodilution and microemboli exposure in MinECC compared to CECC-systems the study aimed to explore the potential neuroprotective effect of MinECC.MethodsIn a prospective randomised design, a consecutive series of CABG patients assigned to either the CECC (n = 40) or the MinECC (n = 38) completed a comprehensive neuropsychological test battery before surgery (T1), and one month (T2) and 6 months (T3) after surgery. Both patient groups were matched on age and education and their performance was compared with matched control subjects. The neurocognitive tasks included measures of mood, speed of information processing, memory, attention and concentration, visuospatial function and executive function in accordance with the guidelines of the consensus statement for cognitive assessment in cardiosurgery (see Stump et al., 1995).ResultsThe two patient groups did not differ on any cognitive variable at T1. At T2, there was a trend towards significantly better performance of the MinECC group compared to the CECC on measures of memory and speed of information processing. Cognitive status at T2 follow-up correlated significantly with age and mood/affect. Both groups showed a large interindividual variability in the direction of pre-post-changes (i.e. improvement vs. deterioration of neurocognitive performance), with evidence of a higher proportion of patients showing a pre-post decline (>20 %) in memory, speed of information processing and attention in the conventional group. The data for neurocognitive status at T3 are currently analysed and will be presented at the meeting.ConclusionsTaken together, the current results offer preliminary evidence that the adoption of MinECC may help to reduce the severity of neurocognitive problems after CABG surgery. BackgroundThe aim of this study was to investigate the course of neurocognitive function in patients who underwent coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) compared to minimized extracorporeal circulation (MinECC) and the surgery and patient-specific factors contributing to cognitive impairment. Given recent reports of reduced hemodilution and microemboli exposure in MinECC compared to CECC-systems the study aimed to explore the potential neuroprotective effect of MinECC. The aim of this study was to investigate the course of neurocognitive function in patients who underwent coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) compared to minimized extracorporeal circulation (MinECC) and the surgery and patient-specific factors contributing to cognitive impairment. Given recent reports of reduced hemodilution and microemboli exposure in MinECC compared to CECC-systems the study aimed to explore the potential neuroprotective effect of MinECC. MethodsIn a prospective randomised design, a consecutive series of CABG patients assigned to either the CECC (n = 40) or the MinECC (n = 38) completed a comprehensive neuropsychological test battery before surgery (T1), and one month (T2) and 6 months (T3) after surgery. Both patient groups were matched on age and education and their performance was compared with matched control subjects. The neurocognitive tasks included measures of mood, speed of information processing, memory, attention and concentration, visuospatial function and executive function in accordance with the guidelines of the consensus statement for cognitive assessment in cardiosurgery (see Stump et al., 1995). In a prospective randomised design, a consecutive series of CABG patients assigned to either the CECC (n = 40) or the MinECC (n = 38) completed a comprehensive neuropsychological test battery before surgery (T1), and one month (T2) and 6 months (T3) after surgery. Both patient groups were matched on age and education and their performance was compared with matched control subjects. The neurocognitive tasks included measures of mood, speed of information processing, memory, attention and concentration, visuospatial function and executive function in accordance with the guidelines of the consensus statement for cognitive assessment in cardiosurgery (see Stump et al., 1995). ResultsThe two patient groups did not differ on any cognitive variable at T1. At T2, there was a trend towards significantly better performance of the MinECC group compared to the CECC on measures of memory and speed of information processing. Cognitive status at T2 follow-up correlated significantly with age and mood/affect. Both groups showed a large interindividual variability in the direction of pre-post-changes (i.e. improvement vs. deterioration of neurocognitive performance), with evidence of a higher proportion of patients showing a pre-post decline (>20 %) in memory, speed of information processing and attention in the conventional group. The data for neurocognitive status at T3 are currently analysed and will be presented at the meeting. The two patient groups did not differ on any cognitive variable at T1. At T2, there was a trend towards significantly better performance of the MinECC group compared to the CECC on measures of memory and speed of information processing. Cognitive status at T2 follow-up correlated significantly with age and mood/affect. Both groups showed a large interindividual variability in the direction of pre-post-changes (i.e. improvement vs. deterioration of neurocognitive performance), with evidence of a higher proportion of patients showing a pre-post decline (>20 %) in memory, speed of information processing and attention in the conventional group. The data for neurocognitive status at T3 are currently analysed and will be presented at the meeting. ConclusionsTaken together, the current results offer preliminary evidence that the adoption of MinECC may help to reduce the severity of neurocognitive problems after CABG surgery. Taken together, the current results offer preliminary evidence that the adoption of MinECC may help to reduce the severity of neurocognitive problems after CABG surgery.