Ann Thorac Cardiovasc Surg. 2026;32(1). doi: 10.5761/atcs.oa.26-00135.
ABSTRACT
PURPOSE: This study aimed to investigate the incidence of postoperative cognitive dysfunction (POCD) in patients undergoing cardiac valve surgery and the potential protective effects of ulinastatin on POCD.
METHODS: This was a prospective, multicenter, randomized, double-blind clinical trial. A total of 300 patients undergoing cardiac valve surgery were enrolled across the 3 hospitals and randomized to the control or ulinastatin treatment groups. The patients’ cognition was evaluated using the Mini-Mental State Examination (MMSE). POCD was defined as a lower cognitive score after surgery than the baseline score. Serum levels of proinflammatory cytokines were measured by an enzyme-linked immunosorbent assay.
RESULTS: The incidence of POCD in the control group was significantly higher than those in the ulinastatin group (42/150 vs. 24/150, p <0.05). The MMSE score in the control group was significantly lower after the operation [D0 vs. D3: 27.72 (1.88) vs. 27.09 (2.61), p <0.05], but did not change in the ulinastatin group [D0 vs. D3: 27.63 (2.29) vs. 27.31 (2.47), p >0.05]. In the ulinastatin group, plasma levels of matrix metallopeptidase 9 (MMP9) and S100 calcium-binding protein B (S100β) were significantly lower than those in the control group after the operation.
CONCLUSIONS: The present study confirms that a transient proinflammatory state impairs cognition in patients undergoing cardiac surgery and indicates that perioperative administration of ulinastatin protects cognition.
PMID:42875195 | DOI:10.5761/atcs.oa.26-00135
