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Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study

Department of Chemical Engineering, Brigham Young University, Provo, Utah

Ramona O Hopkins

Department of Medicine, Pulmonary and Critical Care LDS Hospital, Salt Lake City, Utah and Psychology Department and Neuroscience Center Brigham Young University, Provo, Utah

James W Long

Department of CardioThoracic Surgery LDS Hospital, Salt Lake City, Utah and Department of CardioThoracic Surgery University of Utah, Salt Lake City, Utah

S Fazal Mohammad

Utah Artificial Heart Institute, Salt Lake City, Utah and Department of Pathology University of Utah, Salt Lake City, Utah

Kenneth A Solen

Department of Chemical Engineering, Brigham Young University, Provo, Utah, ken_solen{at}byu.edu

Hypothermia-induced platelet aggregation (HIPA) was previously reported in whole blood exposed to synthetic surfaces at 24°-32°C in one-third of normal subjects tested. Cardiopulmonary bypass, conducted with hypothermia, may lead to such aggregation, resulting in microvascular occlusion contributing to cognitive impairment. This pilot study was conducted to explore the relationship between HIPA and cognitive outcome at hospital discharge in patients undergoing coronary artery bypass graft (CABG) surgery as a first step toward a longer-term study.

Patients (n=45) undergoing mild to moderate hypothermia (32°-28°8C) during CABG surgery underwent cognitive testing preoperatively and prior to hospital discharge. Tests included: visual and verbal memory, mental processing speed, executive function, language, and intellectual function. HIPA was identified using an in vitro assay in which blood flowing in polyvinychloride tubing was subjected to hypothermia, and platelet aggregates were detected using microscopy and passing the exiting blood through a 20-µm pore filter.

Forty-four percent of patients exhibited HIPA. The entire cohort exhibited significant postoperative cognitive decline in verbal memory, mental processing speed and executive function. There was greater cognitive decline in the group with HIPA compared with the group not exhibiting this phenomenon. The patients with HIPA showed significant decline in four of five cognitive measures whereas patients not exhibiting this phenomenon declined in only two of five cognitive measures.

HIPA appears to be associated with an added risk of cognitive decline immediately following CABG surgery employing mild to moderate hypothermia. The findings of our study suggest the long-term cognitive effects of hypothermia-induced platelet aggregation need to be explored.

Perfusion, Vol. 20, No. 3, 157-167 (2005)
DOI: 10.1191/0267659105pf814oa


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