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

Masahiro Ono, Brijen Joshi, Kenneth Brady, R. Blaine Easley, Kathy Kibler, John Conte, Ashish Shah, Stuart D. Russell, Charles W. Hogue

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1022-1028
Number of pages7
JournalJournal of cardiothoracic and vascular anesthesia
Volume26
Issue number6
DOIs
StatePublished - Dec 1 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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