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J Cardiothorac Vasc Anesth. 2012 Dec;26(6):1022-8. doi: 10.1053/j.jvca.2012.07.014.

Cerebral blood flow autoregulation is preserved after continuous-flow left ventricular assist device implantation.

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  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

OBJECTIVE:

To compare cerebral blood flow (CBF) autoregulation in patients undergoing continuous-flow left ventricular assist device (LVAD) implantation with that in patients undergoing coronary artery bypass grafting (CABG).

DESIGN:

Prospective, observational, controlled study.

SETTING:

Academic medical center.

PARTICIPANTS:

Fifteen patients undergoing LVAD insertion and 10 patients undergoing CABG.

MEASUREMENTS AND MAIN RESULTS:

Cerebral autoregulation was monitored with transcranial Doppler and near-infrared spectroscopy. A continuous Pearson correlation coefficient was calculated between mean arterial pressure (MAP) and CBF velocity and between MAP and near-infrared spectroscopic data, rendering the variables mean velocity index (Mx) and cerebral oximetry index (COx), respectively. Mx and COx approach 0 when autoregulation is intact (no correlation between CBF and MAP), but approach 1 when autoregulation is impaired. Mx was lower during and immediately after cardiopulmonary bypass in the LVAD group than in the CABG group, indicating better-preserved autoregulation. Based on COx monitoring, autoregulation tended to be better preserved in the LVAD group than in the CABG group immediately after surgery (p = 0.0906). On postoperative day 1, COx was lower in the LVAD group than in the CABG group, indicating preserved CBF autoregulation (p = 0.0410). Based on COx monitoring, 3 patients (30%) in the CABG group had abnormal autoregulation (COx ≥0.3) on the first postoperative day but no patient in the LVAD group had this abnormality (p = 0.037).

CONCLUSIONS:

These data suggest that CBF autoregulation is preserved during and immediately after surgery in patients undergoing LVAD insertion.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
23122299
[PubMed - indexed for MEDLINE]
PMCID:
PMC3490198
Free PMC Article
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