Postperfusion syndrome

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Post-perfusion syndrome
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This article is about the mental condition. For the term in engineering, see
Bernoulli's equation
.

Postperfusion syndrome, also known as "pumphead", is a constellation of

neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short-term memory, fine motor function, and speed of mental and motor responses.[1] Studies have shown a high incidence of neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment.[1][2]

Evidence

A study by Newman et al. at

control group and is considered level II-3 evidence. Also, the statistical calculation of cognitive decline has been demonstrated as the least reliable due to practice effects, measurement error and the regression to the mean phenomenon.[4]

Subsequent studies have compared "on-pump" CABG to off-pump coronary artery bypass (OPCAB)—essentially establishing controls to compare the incidence of neurocognitive decline in CABG with and without the use of CPB. A small study (60 patients total, 30 in each treatment arm) by Zamvar et al. demonstrated neurocognitive impairment was worse for the on-pump group both 1 week and 10 weeks postoperatively.[5] A larger study (281 patients total) by Van Dijk et al. showed CABG surgery without cardiopulmonary bypass improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.[2] Furthermore, the Van Dijk study showed no difference between the on-pump and off-pump groups in quality of life, stroke rate, or all-cause mortality at 3 and 12 months. A study by Jenson et al. published in Circulation found no significant difference in the incidence of cognitive dysfunction 3 months after either OPCAB or conventional on-pump CABG.[1]

Given the above studies, there is high incidence of neurocognitive deficit shortly after bypass surgery, but evidence is less clear about long-term neurological impairment. Controlled "on-pump" versus "off-pump" cardiac surgery has only been studied in the setting of CABG and is not necessarily generalizable to other types of cardiac surgery. Recent advancements in transcatheter and

percutaneous valve replacement
may soon allow comparison of other types of cardiac surgery with and without CPB.

Neurocognitive deficit as a consequence of vascular disease

A study by McKhann et al.

cerebrovascular disease before surgery; there is no evidence the cognitive test performance of bypass surgery patients differed from similar control groups with coronary artery disease over a 12-month follow-up period. A related study by Selnes et al.[7] concluded patients with coronary artery bypass grafting did not differ from a comparable nonsurgical control group with coronary artery disease 1 or 3 years after baseline examination. This finding suggests that late cognitive decline after coronary artery bypass grafting previously reported by Newman et al. may not be specific to the use of cardiopulmonary bypass, but may also occur in patients with very similar risk factors for cardiovascular and cerebrovascular disease.[3]

Documentary film

In 2020, Australian film director Andrew Pike released Pumphead, a documentary about the condition. The film explores the experiences of eight patients following major heart surgery, describing their experiences with postperfusion syndrome. The filmmaker Andrew Pike experienced pumphead himself, following open-heart surgery in 2011.[8] The film introduces the concept of post-traumatic growth, as a positive psychological change that can follow traumatic experiences such as pumphead.[8]

See also

References

  1. ^
    PMID 16769915
    .
  2. ^
    PMID 11903027
    .
  3. ^
    PMID 11172175
    .
  4. PMID 16337395
    .
  5. PMID 12458242
    .
  6. S2CID 21972340
    .
  7. PMID 15797050
    .
  8. ^ a b "Pumphead Press Kit" (PDF). Ronin Films. 16 October 2020. Retrieved 18 January 2022.

Further reading

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