title: Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study.
abstract: OBJECTIVE
  Neurocognitive impairment can be a debilitating complication after cardiac surgery. The aim of this study was to assess the effect of minimal extracorporeal circulation (MECC) versus conventional extracorporeal circulation (CECC) on neurocognitive function after elective coronary artery bypass grafting (CABG) and whether this can be attributed to improved cerebral perfusion intraoperatively.
  
  
  RESULTS
  64 patients scheduled for elective CABG surgery were prospectively randomly assigned to surgical revascularisation with MECC versus CECC. All patients were continuously monitored for changes in cerebral oxygenation with near-infrared spectroscopy during the procedure. Neurocognitive assessment was performed before surgery, on the day of discharge and at 3 months postoperatively using a battery of standardised neurocognitive tests. Both groups were comparable in terms of demographic and clinical data. MECC was associated with improved cerebral perfusion during cardiopulmonary bypass (CPB). Eleven patients operated on with MECC and 17 with CECC experienced at least one episode of cerebral desaturation (38% vs 55%, p=0.04) with similar duration (10 vs 12.3 min, p=0.1). At discharge patients operated on with MECC showed a significantly improved performance on complex scanning, visual tracking, focused attention and long-term memory. At 3&emsp14;months significantly improved performance was also evident on visuospatial perception, executive function, verbal working memory and short-term memory. Patients operated on with MECC experienced a significantly lower risk of early cognitive decline both at discharge (41% vs 65%, p=0.03) and at 3-month evaluation (21% vs 61%, p<0.01).
  
  
  CONCLUSIONS
  Use of MECC attenuates early postoperative neurocognitive impairment after coronary surgery compared with conventional CPB. This finding may have important implications on the surgical management strategy for coronary artery disease.
  
  
  BACKGROUND
  The study is registered at ClinicalTrials.gov, number NCT01213511.
authors.affiliation: Department of Cardiothoracic Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Anastasiadis
authors.forename: Helena
authors.initials: H
authors.lastname: Argiriadou
authors.forename: Mary H
authors.initials: MH
authors.lastname: Kosmidis
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Megari
authors.forename: Polychronis
authors.initials: P
authors.lastname: Antonitsis
authors.forename: Evanthia
authors.initials: E
authors.lastname: Thomaidou
authors.forename: Eleni
authors.initials: E
authors.lastname: Aretouli
authors.forename: Christos
authors.initials: C
authors.lastname: Papakonstantinou
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D010100:Oxygen