Surface modification of extracorporeal circuits: Is there really an impacton cerebral performance after cardiopulmonary bypass?

Background: Pathophysiology of extracorporeal circulation is multifactorial , and the link between newly developed "biomaterials" and clinical outcome is not easy to illustrate. Material and methods: We designed a randomized, double-blinded, prospective study in order to verify the impact of a new su rface modification [SMAR(X)T] in combination with an optimized blood air in terface, on the cerebral performance after cardiopulmonary bypass. 80 patie nts were randomly divided into two subgroups (SMARxT vs. standard PVC contr ol) and analyzed for the kinetic of cerebral ischemia markers neuronspecifi c enolase, protein S100 and neuropsychologically tested with the Mini-Menta l-Status Test (MMST) before and after the operation. Results: We could not show significant differences of protein S100 and neuron-specific enolase (N SE) levels between SMAR(X)T patients and the controls, but the incidence of neurological complications was exceptionally low. Although no statisticall y significant differences could be obtained for the MMST, the different poi ntloss between both groups trends toward a better cerebral performance in S MAR(X)T patients. Conclusion: The use of a biologically inert circuit in co mbination with an optimized perfusion management seems to be worthy of reco mmendation.