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Review
. 2019 Dec 1;34(6):739-748.
doi: 10.21470/1678-9741-2018-0263.

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

Farshad Hasanzadeh Kiabi  1 , Aria Soleimani  1 , Mohammad Reza Habibi  1
Affiliations
Review

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

Farshad Hasanzadeh Kiabi et al. Braz J Cardiovasc Surg. .

Abstract

Introduction: The true influence of the low mean arterial pressure (low MAP) during coronary artery bypass grafting (CABG) on the development of postoperative cognitive deficit (POCD) remains controversial. We aimed to perform a meta-analysis and meta-regression to determine the effect of low MAP on POCD, as well as moderator variables between low MAP and POCD.

Methods: The Web of Science, PubMed database, Scopus and the Cochrane Library database (up to June 2018) were searched and retrieved articles systematically reviewed. Only randomized controlled trials (RCTs) comparing maintenance of low MAP (<80 mmHg) and high MAP (>80 mmHg) during cardiopulmonary bypass (CPB) were included in our final review. Statistical analysis of the risk ratio (RR) and corresponding 95% confidence interval (CI) was used to report the overall effect. The overall effect and meta-regression analysis were done using Mantel-Haenszel risk ratio (MHRR) and the corresponding 95% confidence interval (CI).

Results: A total of 731 patients in three RCTs were included in this study. POCD occurred in 6.4% of all cases. Maintenance of low MAP did not reduce the occurrence of POCD (MHRR 1.012 [95% CI 0.277-3.688]; Z=0.018; P=0.986; I2=66%). Shorter CPB time reduced the occurrence of POCD regardless of group assignment (MH log risk ratio -0.519 [95% CI -0.949 - -0.089]; Z= -2.367; P=0.017).

Conclusion: POCD is a common event among CABG patients. The neuroprotective effect of low MAP on POCD was attenuated by the prolonged CPB time.

Keywords: Arterial Pressure; Cardiopulmonary Bypass; Cognitive Disorders; Coronary Artery Disorders; Meta-Analysis; Neuroprotective Agents.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the selection process for eligible articles.
Fig. 2
Fig. 2
Comparison of patients in low MAP and high MAP.
Fig. 3
Fig. 3
(A) Plot of MH log RR against age. Values in the horizontal line represent mean age in individual studies. Negative values in vertical axis favor the neuroprotective effect of low MAP (below the horizontal gray line). (B) Plot of MH log RR against CPB time difference. Negative values in horizontal axis indicate a longer mean CPB time for the low MAP group (CPB time difference=high MAP – low MAP). Negative values in vertical axis favor the neuroprotective effect of low MAP (below the horizontal gray line).
See this image and copyright information in PMC

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