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Ann Thorac Surg 1995;59:1331-1335
© 1995 The Society of Thoracic Surgeons

Symposium: Conference on Cardiopulmonary Bypass

Cardiopulmonary Bypass: Perioperative Cerebral Blood Flow and Postoperative Cognitive Deficit

Graham E. Venn, FRCS, Ramesh L. Patel, FRCS(Ed), David J. Chambers, PhD

Cardiac Surgical Research, The Rayne Institute, and Department of Cardiothoracic Surgery, St. Thomas' Campus, Guy's and St. Thomas' Hospital NHS Trust, London, United Kingdom

Abstract

Increased cerebral blood flow occurring during cardiopulmonary bypass as a result of changes in arterial carbon dioxide tension during acid-base regulation is thought to increase postoperative cognitive dysfunction. We studied 70 patients undergoing coronary artery bypass procedures who were randomized to two different acid-base protocols: pH-stat or alpha-stat regulation. Cerebral blood flow, cerebral blood flow velocity, and cerebral oxygen metabolism were measured before bypass, during bypass (hypothermic [28°C] and normothermic phases), and after bypass. Detailed cognitive tests were conducted before operation and 6 weeks after operation. During 28°C bypass, cerebral blood flow was significantly (p < 0.05) higher in the pH-stat group than in the alpha-stat group (41 ± 2 versus 24 ± 2 mL • 100 g-1 • min-1), and cerebral blood flow velocity was significantly increased in the pH-stat group and significantly decreased in the alpha-stat group (152% ± 10% versus 78% ± 7%). Cerebral extraction ratio of oxygen demonstrated a relatively greater disruption of autoregulation in the pH-stat group than in the alpha-stat group with relative hyperemia of 0.12 ± 0.02 versus 0.26 ± 0.03, respectively, during 28°C bypass. Using the criterion of deterioration in three or more neuropsychologic tests, a significantly higher proportion of patients in the pH-stat group fared less well than in the alpha-stat group (49% ± 17% versus 20% ± 13%). Patients in the alpha-stat group experienced less disruption of cerebral autoregulation during hypothermic cardiopulmonary bypass, and this was accompanied by a reduction in postoperative cognitive dysfunction.




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