Cognitive Function Deterioration After Cardiopulmonary Bypass: Can Intraoperative Optimal Cerebral Regional Tissue Oxygen Saturation Predict Postoperative Cognitive Function?

• Published in: Journal of cardiothoracic and vascular anesthesia 2023-05, Vol.37 (5), p.715-723
• Main Authors: Hu, Yu-Ning, Hsieh, Tsung-Hao, Tsai, Meng-Ta, Chien, Chung-Yao, Roan, Jun-Neng, Huang, Yu-Ching, Liang, Sheng-Fu
• Format: Article
• Language: English
• Subjects: Adult; Brain; cardiac surgery; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; cerebral regional tissue oxygen saturation; Cognition; cognitive impairment; Humans; near-infrared spectroscopy; Oxygen; Oxygen Saturation; Prospective Studies
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2023.01.025

[Display omitted] Cognitive impairment is a common neurologic complication after cardiac surgery with cardiopulmonary bypass (CPB). This study evaluated postoperative cognitive function to determine predictors of cognitive dysfunction, including intraoperative cerebral regional tissue oxygen saturation (rSO2). A prospective observational cohort study. At a single academic tertiary-care center. A total of 60 adults undergoing cardiac surgery with CPB from January to August 2021. None. All patients underwent Mini-Mental State Examination (MMSE) and quantified electroencephalography (qEEG) 1 day before cardiac surgery, 7 days postoperatively (POD7), and POD60. Intraoperative cerebral rSO2 was monitored continuously. For MMSE, no significant decrease in MMSE score was found on POD7 versus preoperatively (p = 0.09), but POD60 scores showed significant improvement compared with both preoperative (p = 0.02) and POD7 scores (p < 0.001). On qEEG, relative theta power on POD7 was increased versus preoperatively (p < 0.001), but it was decreased on POD60 (POD7 versus POD60, p < 0.001), and was close to preoperative data (p > 0.99). Baseline rSO2 was an independent factor for postoperative MMSE. Both baseline and mean rSO2 showed a significant influence in postoperative relative theta activity, whereas mean rSO2 was the only predictor for the theta-gamma ratio (p = 0.04). The MMSE in patients undergoing CPB declined at POD7 and recovered by POD60. Lower baseline rSO2 indicated a higher potential for MMSE decline at POD60. Inferior intraoperative mean rSO2 was related to higher postoperative relative theta activity and theta-gamma ratio, implying subclinical or further cognitive impairment.