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(Circulation. 2007;116:1888-1895.)
© 2007 American Heart Association, Inc.

Cardiovascular Surgery

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

George Djaiani, MD, FRCA; Ludwik Fedorko, MD, PhD; Michael A. Borger, MD, PhD; Robin Green, PhD; Jo Carroll, RN; Michael Marcon, PhD; Jacek Karski, MD

From the Department of Anesthesiology (G.D., L.F., J.C., J.K.), Division of Cardiovascular Surgery (M.A.B.), and Toronto Rehabilitation Institute (R.G.), Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; and InControl Technologies Inc, Houston, Tex (M.M.).

Correspondence to George Djaiani, MD, Department of Anesthesia and Pain Management, Eaton North 3-410, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada. E-mail george.djaiani{at}uhn.on.ca

Received February 21, 2007; accepted August 13, 2007.

Background— Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with cell saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery.

Methods and Results— A total of 226 elderly patients were randomly allocated to either cell saver or control groups. Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the cell saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (P=0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups.

Conclusions— The present report demonstrates that processing of shed blood with cell saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass.

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CLINICAL PERSPECTIVE

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