Cognitive dysfunction after cardiopulmonary bypass

Abstract

Cognitive dysfunction remains a significant complication after cardiopulmonary bypass, despite continuous improvement in the overall outcome in open-heart surgery. Embolization of the atheromatous material, most notably during removal of the aortic clamp, is a major cause. Strategies have been developed to minimize cerebral embolization. Modified surgical techniques include the use of hypothermic circulatory arrest, venting of the left ventricle, minimizing aortic manipulation, and the use of epiaortic ultrasound to locate and avoid trauma to the aortic atheromatous plaque. Use of an intra-aortic filter has been shown recently to reduce intraoperative cerebral embolic events and improve postoperative neurocognitive outcomes. Off-pump coronary artery bypass technique has also been claimed to have lower neurological complications, which is probably attributable to the avoidance of aortic cannulation and cardiopulmonary bypass. Its role on cerebral protection is, however, debatable. Chinese Abstract Figure Chinese Abstract.