Effects of balloon-induced pulsatile perfusion on postoperative short- and long-term cognitive dysfunction in diabetic patients with impaired cerebrovascular carbon dioxide reactivity.

OBJECTIVES

The purpose of this study was to identify whether reduced jugular venous oxygen saturation (SjvO(2)) in diabetic patients with impaired cerebrovascular carbon dioxide (CO(2)) reactivity could be improved by pulsatile perfusion during cardiopulmonary bypass (CPB) and whether improved SjvO(2) could improve postoperative cognitive dysfunction after coronary artery bypass graft surgery.

SETTING

A prospective, observational study.

PARTICIPANTS

Ninety-nine diabetic patients with impaired CO(2) reactivity (< 3%/mmHg).

INTERVENTIONS

Ninety-nine diabetic patients divided into 2 groups: group 1 received an intra-aortic balloon pump (IABP) after the induction of anesthesia and group 2 did not. Group 1 received pulsatile perfusion during CPB, and group 2 received nonpulsatile perfusion during CPB.

MEASUREMENTS AND MAIN RESULTS

Hemodynamic data (arterial and jugular venous gas values) were measured during CPB. All patients underwent neurologic and neuropsychologic tests the day before surgery and 7 days and 6 months after surgery. The duration of SjvO(2) ≤50% during CPB was shorter in group 1 (13 ± 5 minutes) than in group 2 (20 ± 6 minutes, p < 0.01). No significant differences in the rate of cognitive dysfunction were observed between groups at 7 days and 6 months postoperatively.

CONCLUSIONS

Pulsatile perfusion flow generated by the IABP could reduce the decrease in SjvO(2) values during CPB, but amelioration of SjvO(2) values was not associated with short- or long-term postoperative cognitive dysfunction in diabetic patients with impaired CO(2) reactivity.