Neuroprotective effects of dynamic bubble trap use in patients undergoing pulmonary endarterectomy: a two-arm randomized controlled trial.
Pulmonary endarterectomy (PEA)
neuroprotection
neuropsychological function
postoperative cognitive function
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
14
05
2021
accepted:
30
07
2021
entrez:
19
11
2021
pubmed:
20
11
2021
medline:
20
11
2021
Statut:
ppublish
Résumé
During cardiosurgical procedures that use extracorporeal circulation (ECC), a variety of neurological complications can occur, and postoperative cognitive deficits remain an unsolved problem. Among the sources of these complications are intraoperatively detectable cerebral microemboli, which mainly consist of air. This study's purpose was to assess neuroprotective effects of reducing these gaseous microemboli using a dynamic bubble trap (DBT) in patients undergoing pulmonary endarterectomy (PEA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Patients undergoing PEA were randomly assigned to receive either a DBT (n=47) or no additional device (controls, n=46) during ECC. Neuropsychological testing was performed before and 3 months after PEA. The primary endpoint was cognitive improvement in the DBT group (n=29) compared with the control group (n=42). As secondary endpoint, ischemic brain micro-lesions were analyzed on postoperative days 6 through 10 using diffusion-weighted magnetic resonance imaging (MRI). Analysis of interaction effects revealed improved performance in visual long-term memory (P=0.008, η DBT positively influences memory function after PEA. This effect is most likely caused by the reduction of gaseous microemboli. This study is registered in the German Clinical Trials Register, ID: DRKS00021499.
Sections du résumé
BACKGROUND
BACKGROUND
During cardiosurgical procedures that use extracorporeal circulation (ECC), a variety of neurological complications can occur, and postoperative cognitive deficits remain an unsolved problem. Among the sources of these complications are intraoperatively detectable cerebral microemboli, which mainly consist of air. This study's purpose was to assess neuroprotective effects of reducing these gaseous microemboli using a dynamic bubble trap (DBT) in patients undergoing pulmonary endarterectomy (PEA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).
METHODS
METHODS
Patients undergoing PEA were randomly assigned to receive either a DBT (n=47) or no additional device (controls, n=46) during ECC. Neuropsychological testing was performed before and 3 months after PEA. The primary endpoint was cognitive improvement in the DBT group (n=29) compared with the control group (n=42). As secondary endpoint, ischemic brain micro-lesions were analyzed on postoperative days 6 through 10 using diffusion-weighted magnetic resonance imaging (MRI).
RESULTS
RESULTS
Analysis of interaction effects revealed improved performance in visual long-term memory (P=0.008, η
CONCLUSIONS
CONCLUSIONS
DBT positively influences memory function after PEA. This effect is most likely caused by the reduction of gaseous microemboli.
TRIAL REGISTRATION
BACKGROUND
This study is registered in the German Clinical Trials Register, ID: DRKS00021499.
Identifiants
pubmed: 34795929
doi: 10.21037/jtd-21-831
pii: jtd-13-10-5807
pmc: PMC8575830
doi:
Types de publication
Journal Article
Langues
eng
Pagination
5807-5817Informations de copyright
2021 Journal of Thoracic Disease. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-831). The following authors report financial activities outside the submitted work: Christoph B. Wiedenroth reports having received lecture honorary from Actelion, Bayer, BTG, MSD and Pfizer. Stefan Guth reports having received lecture honorary from Actelion, Bayer, MSD and Pfizer. The other authors have no conflicts of interest to declare.
Références
Ann Thorac Surg. 2008 Mar;85(3):872-9
pubmed: 18291160
Stroke. 2004 Apr;35(4):888-92
pubmed: 14976326
N Engl J Med. 2001 Feb 8;344(6):395-402
pubmed: 11172175
Perfusion. 2005 May;20(3):151-6
pubmed: 16038387
Hellenic J Cardiol. 2018 Jan - Feb;59(1):16-23
pubmed: 28528258
Psicothema. 2017 Nov;29(4):552-557
pubmed: 29048317
J Heart Lung Transplant. 2018 Jul;37(7):860-864
pubmed: 29550147
Int Psychogeriatr. 1997;9 Suppl 1:115-21
pubmed: 9447434
Eur Heart J. 2010 Feb;31(3):360-8
pubmed: 19541675
Lancet. 2011 Oct 15;378(9800):1379-87
pubmed: 22000135
Stroke. 2001 Dec 1;32(12):2874-81
pubmed: 11739990
Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k
pubmed: 25173341
J Thorac Cardiovasc Surg. 2003 Nov;126(5):1455-60
pubmed: 14666019
Anesth Analg. 2011 May;112(5):1179-85
pubmed: 21474666
J Card Surg. 2015 Nov;30(11):808-12
pubmed: 26395750
Eur Heart J. 2016 Jan 1;37(1):67-119
pubmed: 26320113
Eur Heart J. 2009 Oct;30(20):2493-537
pubmed: 19713419
J Thorac Cardiovasc Surg. 2018 Sep;156(3):1275-1287
pubmed: 29903403
Gen Physiol Biophys. 2006 Jun;25(2):207-14
pubmed: 16917133
Psychosom Med. 2006 May-Jun;68(3):369-75
pubmed: 16738066
Expert Rev Respir Med. 2016 Jun;10(6):673-84
pubmed: 27070482
Anesthesiology. 2009 Mar;110(3):548-55
pubmed: 19225398
Thorac Cardiovasc Surg. 2005 Feb;53(1):33-6
pubmed: 15692916
Br J Anaesth. 2014 Mar;112(3):440-51
pubmed: 24384981
Stroke. 2004 Sep;35(9):e356-8
pubmed: 15284448
Eur Respir J. 2021 Jun 17;57(6):
pubmed: 33334946
Int J Cardiol. 2018 Dec 1;272S:69-78
pubmed: 30195840