Coronary Artery Bypass Clinical Trial
Official title:
Neurocognitive Outcome After Coronary Artery Bypass Surgery Using Minimal Versus Conventional Extracorporeal Circulation
The aim of this study is to assess the effect of minimal (MECC) versus conventional (CECC) extracorporeal circulation on neurocognitive function after elective coronary bypass grafting (CABG) as well as whether this can be attributed to improved cerebral perfusion intraoperatively.
Despite improvements in the biocompatibility of cardiopulmonary bypass (CPB) circuits, the
activation of inflammatory systemic response can result in clinically relevant organ
dysfunction. Regarding the central nervous system, prolonged hypoperfusion and
microembolization during conventional CPB have been related to postoperative neurologic
impairment with an incidence varying from 30% to 60%. This clinical scenario covers a
spectrum from a transient subtle cognitive dysfunction to a permanent stroke. Postoperative
cognitive decline (POCD) is characterized as impairment in attention, cognition,
recognition, orientation, memory, and learning. It may result in prolonged hospitalization,
increased morbidity and mortality, while it has an adverse impact on quality of life after
surgery.
Near-infrared spectroscopy (NIRS) provides a continuous and noninvasive monitoring of
regional cerebral oxygen saturation (rSO2). Recent studies have shown a significant
relationship between intraoperative cerebral oxygen desaturation, indicative of cerebral
ischemia, and early POCD in patients undergoing elective coronary bypass grafting (CABG)
with conventional extracorporeal circulation (CECC). In an attempt to reduce CPB-inherent
side effects, a minimal extracorporeal circulation (MECC) system was developed and it is
evaluated in clinical practice. The aim of this pilot study was to define whether there is a
difference in early postoperative neurocognitive functioning between patients being operated
for CABG on MECC versus CECC systems as well as whether this can be attributed to improved
cerebral perfusion intraoperatively.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
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