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Background: Although mini-cardiopulmonary bypass systems reduce inflammation, hemodilution, and transfusion requirements, the problem of air entrainment and embolization into the system has limited its use. Newer systems incorporate an air purge to address this problem. We compared the benefits and possible risks in using the newer mini-cardiopulmonary bypass system with those for conventional cardiopulmonary bypass. Methods: Data of 60 patients who underwent cardiac surgery with a newer mini-cardiopulmonary bypass system incorporating an air purge from August 2005 to July 2006 (group A) were retrospectively collected and compared with that of 60 matched patients who underwent cardiac surgery with conventional cardiopulmonary bypass during the same period (group B). Matching criteria were prebypass hematocrit, body surface area, age, and surgical procedure. Results: Demographic and background data were similar for both groups. There were no detectable episodes of air embolism. Patients in group A had higher initial and nadir hematocrits during cardiopulmonary bypass and received fewer transfusions. However, postoperative blood loss and transfusion requirements were similar in both groups. Episodes of low indexed flows during cardiopulmonary bypass commonly occurred in group A, and this was associated with a greater than 50% decrease in urine output and lower mixed venous oxygen saturations (58% ± 6% versus 68% ± 5%) as compared with group B. There were no differences in clinical outcomes. Conclusions: The newer mini-cardiopulmonary bypass system addressed the problem of air embolization. It preserved hematocrit and reduced transfusion during cardiopulmonary bypass, but did not improve outcomes postoperatively. It is unclear whether these benefits outweigh the potential risk of hypoperfusion associated with its use. [Copyright &y& Elsevier]

Background: Neurocognitive dysfunction (NCD) after coronary artery bypass graft (CABG) surgery is a common problem. Atherosclerotic disease of the aorta is a known risk factor for stroke after cardiac surgery, but its relationship to NCD is unclear. This study investigates the relationship between aortic atherosclerotic disease and NCD after CABG.Patients and Methods: Patients undergoing primary elective CABG were enrolled in an ongoing investigation of NCD after CABG. Intraoperative transesophageal echocardiography (TEE) of the thoracic aorta was performed and analyzed off-line to quantify atheroma burden. Neurocognitive evaluation was performed, both preoperatively and at 6 weeks after surgery. Multivariable linear regression (controlling for age, years of education, and base line cognitive index) was used to determine the relationship between NCD and atheroma burden in the ascending, arch, and descending aorta.Results: One hundred sixty-two patients who had a complete neurocognitive evaluation and adequate TEE images were studied. No significant relationship was found between NCD and atheroma burden in the ascending (p = 0.22), arch (p = 0.89) or descending aorta (p = 0.64).Conclusions: Although the etiology of NCD is likely multifactorial, our results suggest that aortic atherosclerosis may not be the primary factor in the pathogenesis of post-CABG cognitive changes. [Copyright &y& Elsevier]

Background: Renal dysfunction is a serious complication of cardiac surgery that is highly associated with short- and long-term adverse outcome. While the apolipoprotein E (APOE) ε4 allele has been linked to the occurrence of both postcardiac surgery acute renal injury (ε4 favorable) and ascending aortic arteriosclerosis (ε4 unfavorable), the role of ε4 in the relationship between these two conditions is unknown. We hypothesized that patients with and without the ε4 allele (E4/non-E4) would have different associations between atheroma burden and postoperative renal dysfunction.Methods: Ascending, arch, and descending aorta atheromatous burden and APOE status were evaluated for 130 coronary bypass patients. Multivariable analyses were performed for aortic regions to assess the relationship of atheroma burden and APOE ε4 status with peak in-hospital postoperative serum creatinine. All p < 0.05 were considered significant.Results: We found an interaction between E4 status (E4/non-E4; 24/106) and atheroma burden, with a much greater predicted peak in-hospital postoperative serum creatinine for increases in ascending aorta atheroma load for non-E4 patients versus E4 patients (beta coefficient -0.13; p = 0.002). We also confirmed the association between ascending aorta atheroma and peak creatinine (beta coefficient 0.11; p = 0.0008), after controlling for E4 status, preoperative creatinine, and the E4–atheroma interaction.Conclusions: Equivalent ascending aortic atheroma burden is associated with a greater susceptibility to postoperative renal injury among patients undergoing cardiac operation who lack the APOE ε4 allele. Findings may be attributable to APOE-related differences in inflammation, susceptibility to atheroma detachment (eg, during operative aortic manipulation), or renal vulnerability to embolic injury. [Copyright &y& Elsevier]