Published Online
on October 8, 2007

A more recent version of this article appeared on October 23, 2007

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Submitted on February 21, 2007
Accepted on August 13, 2007

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, and 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.).

^* To whom correspondence should be addressed. E-mail: george.djaiani{at}uhn.on.ca.

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.

Key words: brain • cardiopulmonary bypass • cognitive symptoms • surgical blood loss

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				G. Djaiani, M. Ali, M. A. Borger, A. Woo, J. Carroll, C. Feindel, L. Fedorko, J. Karski, and H. Rakowski Epiaortic Scanning Modifies Planned Intraoperative Surgical Management But Not Cerebral Embolic Load During Coronary Artery Bypass Surgery Anesth. Analg., June 1, 2008; 106(6): 1611 - 1618. [Abstract] [Full Text] [PDF]

				F. D. Rubens, G. A. Wells, and H. J. Nathan Letter by Rubens et al Regarding Article, "Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery" Circulation, May 27, 2008; 117(21): e348 - e348. [Full Text] [PDF]

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