İbrahim KARA, Kaan KIRALİ, Hakan SAÇLI, Yakup TOMAK, Kıyasettin ASİL, Alper ERKİN, Cengiz KÖKSAL

Arteriyel filtre entegreli yeni nesil oksijenatörlerinin nörolojik sonuçlar üzerindeki etkisi

Amaç: Bu çalışmada, koroner arter baypas greftleme yapılan hastalarda, kardiyopulmoner baypasta kullanılan iki farklı oksijenatör sistemi olan, membran oksijenatöre entegreli ve entegresiz arteriyel filtrenin nörokognitif etkileri karşılaştırıldı. Çalışma planı: Bu prospektif, randomize çalışmaya Ocak 2015 - Aralık 2015 tarihleri arasında elektif koroner arter baypas greftleme yapılan toplam 40 hasta (36 erkek, 4 kadın; ort. yaş 60.0±8.5; dağılım 43-75 yıl) alındı. Hastalar kapalı zarf tekniği kullanılarak blok randomizasyon ile iki gruba ayrıldı. Grup 1’de arteriyel filtre entegresiz membran oksijenatörleri ve grup 2’de arteriyel filtre entegreli membran oksijenatörleri kullanıldı. Tüm hastalarda ameliyat sırasında serebral oksijenizasyon yakın kızılötesi spektroskopi ile değerlendirildi. Cerrahi işlemden 2 -4 gün önce ve sonra, beyin difüzyon ağırlıklı manyetik rezonans görüntüleme yapıldı. Bilişsel fonksiyonlar ameliyat sonrası birinci ayda Montreal Bilişsel Değerlendirme testi ile değerlendirildi. Bulgular: Difüzyon ağırlıklı manyetik rezonans görüntülemede entegresiz grupta 11 hastada ve entegreli grupta yedi hastada yeni lezyonlar saptandı. Ameliyat öncesi ve sonrası toplam Montreal Bilişsel Değerlendirme skoru entegresiz ve entegreli grupta sırasıyla ortalama 27.9±3.3’e kıyasla 28.1±3.4 ve 26.2±3.1’e kıyasla 26.8±3 idi. Gruplar arasında yeni lezyon sayısı, yakın kızılötesi spektroskopi bulguları ve Montreal Bilişsel Değerlendirme skorları açısından istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Arteriyel filtre entegreli membran oksijenatörlerin, koroner arter baypas greftleme yapılan hastalarda, nörokognitif sonuçlar açısından, arteriyel filtresi entegre olmayan membran oksijenatörlere kıyasla, anlamlı bir üstünlükleri var gibi görünmemektedir.

The impact of new generation oxygenators with integrated arterial filters on neurological outcome

Background: This study aims to compare the neurocognitive effects of two different oxygenator systems, i.e. membrane oxygenator with or without integrated arterial filters, used during cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.Methods: This prospective, randomized study included a total of 40 patients (36 males, 4 females; mean age 60.0±8.5 years; range 43 to 75 years) who underwent elective coronary artery bypass grafting between January 2015 and December 2015. The patients were divided into two groups by block randomization using the sealed envelope technique. In group 1, non-integrated arterial filter membrane oxygenators and, in group 2, integrated arterial filter membrane oxygenators were used. Near-infrared spectroscopy was used to assess the cerebral oxygenation intraoperatively in all patients. Cranial diffusion-weighted magnetic resonance imaging was performed 2-4 days before and after the surgical procedure. Cognitive functions were evaluated using the Montreal Cognitive Assessment at the postoperative one month.Results: Eleven patients in the non-integrated group and seven patients in the integrated group had new lesions in the diffusion-weighted magnetic resonance imaging. The mean pre- and postoperative total Montreal Cognitive Assessment scores were 27.9±3.3 vs 28.1±3.4 and 26.2±3.1 vs 26.8±3, respectively, in the non -integrated and integrated groups. There were no statistically significant differences between the two groups in terms of the number of new lesions, the near-infrared spectroscopy findings, and the Montreal Cognitive Assessment scores.Conclusion: Membrane oxygenators with integrated arterial filters do not seem to offer a significant advantage over those without integrated arterial filters in terms of neurocognitive outcomes in patients undergoing coronary artery bypass grafting.

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