title: Early benefit of preserved cognitive function is not sustained at one-year after cardiac surgery: a longitudinal follow-up of the randomized controlled trial.
abstract: OBJECTIVE
  Recently, we showed that processing of shed blood with a continuous-flow cell saver during cardiopulmonary bypass resulted in a clinically significant reduction in postoperative cognitive decline (POCD) six weeks after coronary artery bypass graft (CABG) surgery. The current study examined if the early benefit of reduced POCD was sustained in the same patient population at one-year follow-up.
  
  
  METHODS
  One hundred seventy patients (cell saver group, n = 84; controls, n = 86) underwent neuropsychological testing at baseline and one year after surgery. The raw scores for each test were converted to Z-scores, and a combined Z-score of ten main variables was then calculated for each study group.
  
  
  RESULTS
  Postoperative cognitive decline was present in 16 of 84 (19%) patients in the cell saver group (95% confidence interval [CI], 10.8 to 27.2) vs 15 of 86 (17.4%) patients in the control group (95% CI, 9.6 to 25.2) (P = 0.786). Six of the 15 patients in the control group with POCD at six weeks had the impairment at one year and five did not; four were lost to follow-up. Three of the six cell saver patients with POCD at six weeks still had impairment at one year, two did not, and one was not tested. Thirteen (15.4%) and nine (10.5%) patients in the cell saver and control groups, respectively, developed new POCD which was not evident at the six-week follow-up.
  
  
  CONCLUSIONS
  The short-term preservation of cognitive function in elderly patients using the cell saver management strategy did not translate into a long-term benefit one year after CABG surgery. The presence of progressing cerebrovascular disease may be responsible for the long-term cognitive decline.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada. george.djaiani@uhn.ca
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
authors.forename: Ludwik
authors.initials: L
authors.lastname: Fedorko
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Robin
authors.initials: R
authors.lastname: Green
authors.forename: Jo
authors.initials: J
authors.lastname: Carroll
authors.forename: Jacek
authors.initials: J
authors.lastname: Katski
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013997:Time Factors