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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Ono, M; Joshi, B; Brady, K; Easley, RB; Kibler, K; Conte, J; Shah, A; Russell, SD; Hogue, CW

Published Date

  • December 2012

Published In

Volume / Issue

  • 26 / 6

Start / End Page

  • 1022 - 1028

PubMed ID

  • 23122299

Pubmed Central ID

  • 23122299

Electronic International Standard Serial Number (EISSN)

  • 1532-8422

Digital Object Identifier (DOI)

  • 10.1053/j.jvca.2012.07.014

Language

  • eng

Conference Location

  • United States