Background: Whether perioperative glycemic control or markers of inflammation is associated with neurocognitive decline (NCD) after cardiac surgery was examined. Methods: Thirty patients undergoing cardiac surgery utilizing cardiopulmonary bypass (CPB) were screened for NCD preoperatively and on post-operative day four (POD4). Serum cytokine levels were measured and human transcriptome analysis was performed on blood samples. Neurocognitive data are presented as a change from baseline to POD4 in a score standardized with respect to age and gender. Results: A decline in neurocognitive function was identified in 73% (22/30) of patients on POD4. Patients with postoperative leukocytosis (WBC ≥ 10.5) had more NCD when compared to their baseline function (p=0.03). Patients with elevated IL-8 levels at 6 hours postoperatively had a significant decline in NCD at POD4 (p=0.04). Surprisingly, TNF-α, IL-1β, IL-2, or IL-6 levels were not associated with NCD (p>0.3 for all). There was no difference in neurocognitive function between patients with elevated HbA1c levels preoperatively (p=0.973) or elevated fasting blood glucose levels the morning of surgery (>126mg/dL, p=0.910), or a higher maximum blood glucose levels during CPB (>180mg/dL, p=0.252), or higher average glucose levels during CPB (>160mg/dL, p=0.639). Human transcriptome analysis demonstrated unique and differential patterns of gene expression in patients depending on the presence of DM and NCD. Conclusions: Perioperative glycemic control does not have an effect on NCD soon after cardiac surgery. Postoperative leukocytosis and elevated IL-8 levels are associated with neurocognitive decline. The profile of gene expression was altered in patients with NCD with or without diabetes.

Objectives: With recent advances in left ventricular assist device (LVAD) technology, the utilization of LVADs has increased while mortality, cost, and length of stay (LOS) have significantly decreased. This study sought to determine the national trends of surgically implanted biventricular assist devices (BiVADs). Methods: This is a retrospective analysis of the National Inpatient Sample (NIS) database for internal BiVADs (n = 538) and external BiVADs (n = 727) from 2009 to 2015. Results: Utilization of all surgically implanted BiVADs decreased (4.8% per year, p < 0.001), and was driven by a decline in utilization of external BiVADs (9.4% per year, p < 0.001). There was no significant change in BiVAD-associated mortality. However, cost and LOS increased significantly, and these trends were isolated to patients who died during their hospitalization. Patients with internal BiVADs incurred higher cost than external BiVAD patients but were more likely to survive. Conclusions: The decline in surgically implanted BiVAD utilization may be due to an improvement in LVAD technology as well as an increase in the availability of percutaneous temporary circulatory support. Future prospective studies are needed to compare various BiVAD configuration strategies and to optimize BiVAD patient selection and perioperative care.