Preventing Brain Damage after Bypass Surgery

Preoperative administration of Alpha 1 anti-trypsin can prevent post cardiac surgery brain injury as well as short and long term cognitive loss.


he burden of Post Coronary Artery Bypass Surgery (CABG) morbidity cannot be overlooked given the frequency of the procedure on a global basis as well as the associated risk of adverse neurological outcomes. An estimated 2 million CABG procedures are performed yearly worldwide.

Post-cardiac Surgery Cognitive Dysfunction or Cognitive Decline affects 30% to 60% of patients after conventional cardiac surgery and 50% of them will suffer from long-term cognitive decline. In addition to its detrimental effects on patients’ quality of life, the public health implications of adverse neurological outcomes in cardiac surgery include increased length of hospitalizations and use of long-term care facilities.

Postoperative Cognitive Decline (POCD) is defined as a disorder in thought processes which affects cognition in terms of memory, executive function, language, visuospatial interpretation, comprehension, motor speed and attention, compromising normal functioning. Perioperative cognitive decline is predictive of long-term cognitive dysfunction, reduced quality of life, and increased mortality.

Advanced imaging techniques, such as dynamic contrast enhancement (DCE) and magnetic resonance imaging (MRI), have revealed a correlation between disruption of the blood-brain barrier (BBB) and the deterioration of cognitive function after CABG surgery. These findings have important implications for understanding and potentially addressing postoperative neurocognitive decline.



Dr Dan Abramov, Soroka Medical Center

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Sari Prutchi Sagiv PhD. Director of Pharma and Diagnostics

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We propose the preoperative administration of the protein Alpha 1 anti-trypsin (A1AT) to ameliorate post cardiac surgery brain injury.
Our previous studies have showed statistically significant postoperative disruption of blood brain barrier as well as gray and white matter injury in patients undergoing coronary artery bypass grafting as determined by DTI and DCE-MRI techniques.
Following the preoperative administration of AAT-1, post-surgery MRIs showed almost no signs of brain injury.

Given the large volume of cardiac bypass grafting surgery performed on a global scale and the impact of these procedures on adverse neurological outcomes, research should be directed to prevent the burden of post-operative morbidity to both individuals and health care systems as a whole.

We have completed a POC in 11 patients. We believe that the next step for evaluating the potency of AAT-1 in mitigating postoperative neurological sequelae is a larger, randomized controlled study.

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