Cerebral Blood Flow Autoregulation Is Preserved After Continuous-Flow Left Ventricular Assist Device Implantation

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• 作者：Masahiro Ono ; MD ; PhD^? ; Brijen Joshi ; MD^&Dagger ; ; Kenneth Brady ; MD^§ ; ; R. Blaine Easley ; MD^§ ; ; Kathy Kibler ; MS^§ ; ; John Conte ; MD^? ; Ashish Shah ; MD^? ; Stuart D. Russell ; MD^&dagger ; ; Charles W. Hogue ; MD^&Dagger ; ; ^{chogue2@jhmi.edu}
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：26
• 期：6
• 页码：1022-1028
• 全文大小：395 K

文摘

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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 (m>pm> = 0.0906). On postoperative day 1, COx was lower in the LVAD group than in the CABG group, indicating preserved CBF autoregulation (m>pm> = 0.0410). Based on COx monitoring, 3 patients (30 % ) in the CABG group had abnormal autoregulation (COx ¡Ý0.3) on the first postoperative day but no patient in the LVAD group had this abnormality (m>pm> = 0.037).

Conclusions

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