Surgical Technique
Standard cardiac surgical technique was utilized including induction of
general anesthesia, invasive monitoring, midline sternotomy or anterior
thoracotomy for minimally invasive cases, and systemic heparinization.
Cerebral oxygenation was measured in all patients per usual protocol.
CPB was initiated via cannulation of the right atrium and ascending
aorta with a non-pulsatile system, membrane oxygenator, and an arterial
filter. All patients underwent hypothermic CPB with intermittent cold
blood cardioplegia. Intraoperative serum glucose levels were monitored
and maintained at a goal of <200mg/dL by intravenous insulin
administration. All patients had intra-operative transesophageal
echocardiography and ejection fraction was determined at the beginning
of the case by a cardiac anesthetist. Post-operatively, if any patients
were unable to be extubated within a reasonable time and complete the
fast-tracking to discharge and able to perform the neurocognitive
assessment on POD4, they were excluded from analysis.