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Randomized Controlled Trial
. 2021 Jan 22;32(2):229-235.
doi: 10.1093/icvts/ivaa264.

Associations between mean arterial pressure during cardiopulmonary bypass and biomarkers of cerebral injury in patients undergoing cardiac surgery: secondary results from a randomized controlled trial

Sebastian Wiberg  1 , Frederik Holmgaard  2 , Kaj Blennow  3   4 , Jens C Nilsson  2 , Jesper Kjaergaard  1 , Michael Wanscher  2 , Annika R Langkilde  5 , Christian Hassager  1   6 , Lars S Rasmussen  6   7 , Henrik Zetterberg  3   4   8   9 , Anne Grønborg Vedel  2
Affiliations
Randomized Controlled Trial

Associations between mean arterial pressure during cardiopulmonary bypass and biomarkers of cerebral injury in patients undergoing cardiac surgery: secondary results from a randomized controlled trial

Sebastian Wiberg et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: Cardiac surgery is associated with risk of cerebral injury and mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) is suggested to be associated with cerebral injury. The 'Perfusion Pressure Cerebral Infarcts' (PPCI) trial randomized patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement to a MAP of 40-50 or 70-80 mmHg during CPB and found no difference in clinical or imaging outcomes between the groups. We here present PPCI trial predefined secondary end points, consisting of biomarkers of brain injury.

Methods: Blood was collected from PPCI trial patients at baseline, 24 and 48 h after induction of anaesthesia and at discharge from the surgical ward. Blood was analysed for neuron-specific enolase, tau, neurofilament light and the glial marker glial fibrillary acidic protein. Linear mixed models were used to analyse differences in biomarker value changes from baseline between the 2 MAP allocation groups.

Results: A total of 193 (98%) patients were included. We found no differences in biomarker levels over time from baseline to discharge between the 2 MAP allocation groups (PNSE = 0.14, PTau = 0.46, PNFL = 0.21, PGFAP = 0.13) and the result did not change after adjustment for age, sex and type of surgery.

Conclusions: We found no significant differences in levels of biomarkers of neurological injury in patients undergoing elective or subacute CABG and/or aortic valve replacement randomized to either a target MAP of 40-50 mmHg or a target MAP of 70-80 mmHg during CBP.

Keywords: Aortic valve replacement; Biomarkers; Coronary artery bypass grafting; Neurological injury.

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Figures

Figure 1:
Figure 1:
Median (interquartile range) biomarker levels from baseline to discharge, stratified by MAP allocation. Cardiac surgery patients randomized to a mean arterial blood pressure of either 40–50 mmHg (low) or 70–80 mmHg (high). MAP: mean arterial pressure.
None
See this image and copyright information in PMC

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