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.