Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion

İpek Bostancı; Beyhan Güner; Evrim Kucur Tülübaş; Güray Demir; Zafer Çukurova

doi:10.4274/TJAR.2024.231331

Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion

Turk J Anaesthesiol Reanim. 2024 Feb 28;52(1):22-29. doi: 10.4274/TJAR.2024.231331.

Authors

İpek Bostancı¹, Beyhan Güner¹, Evrim Kucur Tülübaş¹, Güray Demir², Zafer Çukurova¹

Affiliations

¹ University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Turkey.
² University of Health Sciences Turkey, Taksim Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Turkey.

Abstract

Objective: We aimed to evaluate the effects of cardiopulmonary bypass (CPB) machines used in coronary artery bypass grafting surgeries on cerebral perfusion by performing cerebral oximetry monitoring [near-infrared spectroscopy (NIRS)], S100-β protein measurements, and neurocognitive function assessment tests using both pulsatile and non-pulsatile modes.

Methods: A total of 44 patients, 22 non-pulsatile (Group NP) and 22 pulsatile (Group P), were included in the study. Hemodynamic parameters, arterial blood gas values, NIRS values and blood S100β protein levels were analyzed at five points: pre-induction (T1), initiation of CPB (T2), termination of CPB (T3), end of surgery (T4), and postoperative 24 h (T5). Two different neuropsychological tests were administered to patients in the preoperative and postoperative periods.

Results: There were no significant differences between the groups for demographic characteristics such as age, gender, body mass index, aortic cross-clamping, CPB, and operation durations. The mean arterial blood pressure and PaO₂ values for the T2 measurements were significantly higher in group NP (P < 0.05). Regional cerebral oxygen saturation (rSO₂) (NIRS) values at T3 and T4 were significantly higher in group P (P < 0.05). Serum S100β measurement values at T3 and T5 were significantly higher in group NP than in group P (P < 0.05). Serum S100β protein levels at T3 correlate with rSO₂ results. There was no statistically significant difference between the two groups in terms of pH, lactate, glucose, partial pressure of carbon dioxide, and peripheral oxygen saturation values.

Conclusion: Despite no difference between the two groups for neurocognitive function tests, we believe that pulsatile perfusion may be more beneficial for cerebral perfusion when S100β protein and NIRS values are considered. Further clinical studies are needed to evaluate the benefits of the pulsatile technique for cerebral perfusion.

Keywords: Cardiopulmonary bypass; S100β protein; cardiovascular and thoracic anaesthesia; near-infrared spectroscopy; postoperative cognitive disfunction; pulsatile flow.