Comparison of the Effect of Pump Flow Type (Pulsatile or Non-Pulsatile) on Postoperative Neurocognitive Functions in Coronary Artery Surgery

Borulu, Ferhat; Erkut, Bilgehan

doi:10.21470/1678-9741-2023-0345

Brasil

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ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 39 (5) • 2024 • https://doi.org/10.21470/1678-9741-2023-0345 linkcopy

Comparison of the Effect of Pump Flow Type (Pulsatile or Non-Pulsatile) on Postoperative Neurocognitive Functions in Coronary Artery Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction: The effect of pump flow type on perfusion in coronary surgery using cardiopulmonary bypass (CPB) is discussed. We aimed to evaluate the effect of pump flow type on cognitive functions with neurocognitive function tests.

Methods: One hundred patients who underwent isolated coronary artery bypass surgery between November 2020 and July 2021 were divided into two equa groups. Groups were formed according to pump flow type pulsatile (Group 1) and non-pulsatile (Group 2). Clock drawing test (CDT) and standardized mini mental test (SMMT) were performed on the patients in both groups in the preoperative period, on the 1st preoperative day, and on the day before discharge. Neurocognitive effects were compared with all follow-up parameters.

Results: There was no difference between the groups in terms of demographic data and in terms of neurocognitive tests performed before the operation. SMMT on postoperative day 1 (Group I: 27.64 ± 1.05; Group II: 24.44 ± 1.64; P=0.001) and CDT (Group I: 5.4 ± 0.54; Group II: 4 .66 ± 0.52; P=0.001), and SMMT on the day before discharge (Group I: 27.92 ± 1.16; Group II: 24.66 ± 1.22; P=0.001) and CDT (Group I: 5 It was calculated as .66 ± 0.48; Group II: 5.44 ± 0.5; P=0.001). The duration of intensive care and hospitalization were higher in the non-pulsatile group.

Conclusion: We think that the type of pump flow used in coronary artery bypass surgery using CPB is effective in terms of neurocognitive functions and that pulsatile flow makes positive contributions to this issue.

Keywords: Cardiopulonary Bypass; Patient Discharge; Pulsative Flow; Coronary Artery Bypass; Cognition; Mental Status and Dementia Test; Intelligence Tests; Critical Care

Parameters	Group 1 (pulsatile) (n: 50)	Group 2 (non-pulsatile) (n: 50)	P-value
Age (years)	60.02 ± 9.16	61.72 ± 8.76	0.289*
Male sex (n/%)	37 (74%)	36 (72%)	0.500**
Female sex (n/%)	13 (26%)	14 (28%)	0.500**
BMI (kg/m²)	27.57 ± 2,9	27.8 ± 3.01	0.833*
BSA (m²)	1.95 ± 0.17	1.97 ± 0.16	0.588*
Hypertension (n/%)	17 (34%)	20 (40%)	0.339**
DM (n/%)	20 (40%)	16 (32%)	0.266**
Cigarette (n/%)	20 (40%)	17 (34%)	0.339**
Hyperlipidemia (n/%)	17 (34%)	12 (24%)	0.189**
Preoperative EF (%)	51.62 ± 5.97	49.96 ± 5.89	0.170*
CCPD (n/%)	4 (8%)	8 (16%)	0.178**
PAD (n/%)	2 (4%)	4 (8%)	0.339**
CRF (n/%)	1 (2%)	2 (4%)	0.554**
EuroSCORE II	1.33 ± 0.49	1.25 ± 0.44	0.415*

Parameters	Group 1 (pulsatile) (n: 50)	Group 2 (non-pulsatile) (n: 50)	P-value
CPB time (min.)	91.41 ± 17.47	93.74 ± 18.17	0.305^* * Mann-Whitney U test
Cross-clamping time (min.)	44.18 ± 10.28	47.1 ± 14.67	0.411^* * Mann-Whitney U test
Number of vessels (n)	3.06 ± 0.82	3.15 ± 0.89	0.301
Body temperature (°C)	32.52 ± 0.9	31.66 ± 0.85	0.864
Perfusion current (ml/min)	4130 ± 292.75	4095 ± 301.45	0.324
Pre-induction MAP (mmHg)	67.8 ± 10.19	68.56 ± 11.66	0.928
CPB entry MAP (mmHg)	67.18 ± 7.1	68.64 ± 10.53	0.661
5^th minute CPB MAP (mmHg)	62.24 ± 6.77	60.9 ± 8.25	0.318
10^th minute cross-clamping MAP (mmHg)	61.28 ± 7.74	59.22 ± 9.53	0.125
20^th minute cross-clamping MAP (mmHg)	60.44 ± 8.5	58.68 ± 9.3	0.427
CPB exit MAP (mmHg)	59.46 ± 8.63	59.74 ± 8.16	0.839

Parameters	Group 1 (pulsatile) (n: 50)	Group 2 (non-pulsatile) (n: 50)	P-value
CPB entry
PH	7.32 ± 0.06	7.32 ± 0.05	0.754
pO₂	244.84 ± 53.44	240.18 ± 57.09	0.484
pCO₂	43.09 ± 5.09	43.62 ± 5.73	0.756
Saturation	99.06 ± 0.64	99.01 ± 0.66	0.361
Na	137.48 ± 2.63	137.2 ± 3.06	0.626
Glucose	158.74 ± 37.47	147.61 ± 41.9	0.093
Lactate	1.95 ± 0.72	1.72 ± 0.72	0.077
Hgb	6.91 ± 1.14	7.12 ± 1.43	0.473
Hct	21.66 ± 3.76	22.22 ± 4.34	0.544
Cross-clamping (5 min.)
PH	7.33 ± 0.04	7.34 ± 0.06	0.396
pO₂	186.08 ± 44.67	187.36 ± 45.19	0.953
pCO₂	39.62 ± 5.99	39.29 ± 7.94	0.410
Saturation	98.68 ± 0.79	98.66 ± 1.55	0.262
Na	138.56 ± 2.87	138.48 ± 3.54	0.523
Glucose	205.96 ± 38.39	195.28 ± 43.96	0.288
Lactate	2.76 ± 0.97	3.05 ± 2.46	0.972
Hgb	7.82 ± 1.08	7.97 ± 1.34	0.831
Hct	23.95 ± 2.85	24.68 ± 4.11	0.565
Cross-clamping (10 min.)
pH	7.3 ± 0.07	7.32 ± 0.08	0.065
pO₂	208.1 ± 50.35	214.58 ± 53.99	0.345
pCO₂	43.78 ± 5.48	41.22 ± 5.32	0.032*
Saturation	99.16 ± 1.09	98.5 ± 1.62	0.004**
Na	140.24 ± 2.85	140.68 ± 4.07	0.751
Glucose	178.28 ± 32.73	181.38 ± 36.26	0.730
Lactate	2.63 ± 0.79	2.85 ± 1	0.292
Hgb	6.62 ± 0.49	6.61 ± 0.63	0.779
Hct	21.1 ± 1.35	20.99 ± 1.72	0.828
Cross-clamping (20 min.)
pH	7.28 ± 0.06	7.31 ± 0.07	0.005**
pO₂	203.76 ± 44.83	194.98 ± 42.7	0.244
pCO₂	42.99 ± 5.52	40.11 ± 4.79	0.007**
Saturation	99.22 ± 1.08	99.12 ± 1.05	0.112
Na	139.12 ± 2.02	139.04 ± 3.79	0.540
Glucose	181.62 ± 44.2	182.1 ± 29.89	0.631
Lactate	3.07 ± 0.92	2.91 ± 0.99	0.415
Hgb	6.84 ± 0.48	6.94 ± 0.6	0.258
Hct	21.46 ± 1.31	21.53 ± 3.18	0.227
CPB exit
pH	7.34 ± 0.05	7.36 ± 0.06	0.138
pO₂	192,76 ± 29,94	188.56 ± 32.26	0.329
pCO₂	39.85 ± 5.13	38.66 ± 5.54	0.334
Saturation	99.16 ± 0.57	98.92 ± 0.78	0.110
Na	138.82 ± 1.72	139.2 ± 1.98	0.311
Glucose	208.88 ± 39.38	185.32 ± 42.34	0.004**
Lactate	2.86 ± 1.13	2.85 ± 1.42	0.588
Hgb	7.85 ± 0.83	8.01 ± 0.96	0.541
Hct	24.11 ± 2.44	24.99 ± 2.79	0.164

		Group 1 (pulsatile) (n:50)	Group 2 (non-pulsatile) (n:50)	P-value
Clock drawing test	Preoperative	5.64 ± 0.49	5.54 ± 0.5	0.312
	Postop. 1^st day	5.4 ± 0.54	4.66 ± 0.52	*0.001^ * P<0.01**
	Before discharge	5.66 ± 0.48	5.44 ± 0.5	*0.001^ * P<0.01**
Standardized mini mental test	Preoperative	28.14 ± 1.18	28 ± 1.25	0.569
	Postop. 1^st day	27.64 ± 1.05	24.44 ± 1.64	*0.001^ * P<0.01**
	Before discharge	27.92 ± 1.16	24.66 ± 1.22	*0.001^ * P<0.01**

Parameters	Group 1 (pulsatile) (n: 50)	Group 2 (non-pulsatile) (n: 50)	P-value
Intubation time (hour)	8.83 ± 6.88	8.52 ± 9.36	0.478
ICU follow-up time (hours)	70 ± 28.17	53.26 ± 18.87	*0.001^ * Mann-Whitney U test**
Hospitalization time (days)	6.66 ± 1.12	7.62 ± 1.98	*0.001^ * Mann-Whitney U test**
Postop. 1^st day
Hgb (g/dl)	9.08 ± 0.9	9.14 ± 1.17	0.619
Hct (%)	27.37 ± 2.83	26.92 ± 3.02	0.512
Creatine (mg/dL)	1.47 ± 3.02	1.07 ± 0.28	0.956
BUN (mg/dl)	24.62 ± 6.53	24.67 ± 8.41	0.544
KCl (mEq/L)	4.13 ± 0.24	4.11 ± 0.42	0.718
Na (mmol/L)	141.84 ± 3.25	142.6 ± 4.92	0.516
Ca (mg/dL)	8.63 ± 0.52	8.69 ± 0.61	0.689
Postop. 5^th day
Hgb (g/dl)	9.46 ± 0.72	9.35 ± 0.9	0.286
Hct (%)	29.39 ± 1.96	29.24 ± 2.15	0.761
Creatine (mg/dL)	1.16 ± 0.17	1.14 ± 0.2	0.519
BUN (mg/dl)	26.24 ± 6.34	26.48 ± 6.33	0.992
KCl (mEq/L)	4.06 ± 0.37	4.01 ± 0.27	0.911
Na (mmol/L)	139.98 ± 2.7	139.3 ± 2.12	0.065
Ca (mg/dL)	8.92 ± 0.75	8.63 ± 0.42	0.073
Blood transfusions
ES (n)	2.34 ± 0.63	2.42 ± 0.61	0.204
FFP (n)	2.39 ± 0.76	2.35 ± 0.54	0.358

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[TFN1] BMI=body mass index; BSA=body surface area; CCPD=chronic obstructive pulmonary disease; CRF=chronic renal failure; DM=diabetes mellitus; EF=ejection fraction; EuroSCCRE=European System for Cardiac Operative Risk Evaluation; PAD=peripheral artery disease

[TFN2] ^*
Mann-Whitney U test; **Chi-square analysis