Limiting brain and lung damage after coronary artery bypass grafting: An alternative to conventional coronary artery bypass graft

Abstract

Summary:The development of coronary artery bypass graft (CABG) for the treatment of coronary heart disease has resulted in reduced morbidity and mortality compared with medical therapy. Even with the rapid development of improved percutaneous interventions, CABG remains an important approach for treating patients with advanced coronary heart disease. However, recent studies and commentary reporting an alarmingly high incidence of subtle, cognitive decline following CABG have generated questions about whether these adverse outcomes could be lessened. Even after considerable study, there is no consensus as to the cause of brain and lung injury after CABG and cardiopulmonary bypass, nor an agreed upon, mechanistic approach to study its prevention. The potential causes of these adverse outcomes and a simple approach are described, involving the use of the cannulae, biventricular pulsatile flow pump, and a blood substitute to optimize the perfusion of brain and alveolar cells, minimize systemic microembolization, and limit post-CABG cognitive decline.

Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach

“…Randomized study 100 Belgium Effectiveness Driessen et al 53 1995 Randomized study 38 Belgium Effectiveness Murkin et al 55 1995 Randomized study 316 Canada Effectiveness Abramov et al 51 2003 Cohort study 1820 Canada Effectiveness for exclusion were different target population (7 studies), 9,[19][20][21][22] different intervention (6 studies), [23][24][25][26][27][28] outcome of interest was not measured (24 studies), 7,10-12,29-48 and multiple reasons (2 studies). 49,50 Eight studies involving 2503 patients met the inclusion criteria of this review.…”

“…Thirty‐nine studies were excluded after examining the entire manuscript. The reasons for exclusion were different target population (7 studies), 9,19–22 different intervention (6 studies), 23–28 outcome of interest was not measured (24 studies), 7,10–12,29–48 and multiple reasons (2 studies) 49,50 …”

Manual Assessment of the Initial Fall in Blood Pressure After Orthostatic Challenge at High Altitude

“…8 Previous studies including a total of 47 participants have measured BP changes in response to head up tilt (HUT) at high altitude. [2][3][4]9 This procedure eliminates the contraction of the calf muscles, which promotes venous return, and so may be less relevant in terms of dizziness occurring during normal activities. These studies did not measure BP immediately after a change in posture.…”