WINSTON-SALEM, N.C. – Researchers at Wake Forest University Baptist Medical Center have received a $3.6 million federal grant to identify ways to reduce some of the complications that can occur in diabetic patients after heart surgery.
The study, which will involve 564 patients, will focus on cognitive problems such as deficits in memory, concentration and attention that can occur after surgery to replace valves or bypass blocked arteries. Researchers will determine whether better management of blood sugar levels can reduce these problems and whether genetic tests can determine which patients are most at risk.
“Our goal is to apply what we’ve learned about reducing these complications in the general population to patients with diabetes,” said John Hammon, M.D., cardiothoracic surgeon and lead investigator. “Our overall goal is to make these lifesaving surgeries even safer for patients.”
Diabetes is a major risk factor for atherosclerosis, the buildup of fatty deposits in the blood vessels that can lead to heart attack and stroke. Surgery to bypass blocked arteries or replace valves can be lifesaving, but it can also lead to cognitive deficits after surgery. The cause is believed to be emboli, small particles made up of fatty deposits and other materials.
These materials can block small vessels as well as cause inflammation of the vessels – which can both lead to brain injury. Medical Center researchers have conducted significant research since the early 1990s on how to reduce the number of emboli and resulting cognitive problems, and they have published more than 25 papers on the subject. They’ve found that controlling body temperature, using fewer clamps on the aorta, the body’s main artery, and processing blood from the operative field with a cell saver device to remove impurities are important factors.
The grant, from the National Institutes of Health, is aimed at patients with diabetes because they are at increased risk of heart disease – which may result in surgery – and of having vessel inflammation. One study has shown that the level of brain injury in diabetic patients who’ve undergone heart surgery can be twice as high as in non-diabetic patients.
Study patients will receive the improved surgical techniques that Hammon and colleagues have identified through their earlier research. In addition, the researchers will evaluate vessel health in patients prior to surgery to determine whether careful management of blood sugar levels during surgery will prevent an increase in inflammation. They will also test cognition before and after surgery.
In addition, the researchers will analyze blood samples from the patients to determine if having specific genetic variants affects the risk of brain injury or having blood sugar problems during surgery.
Study participants will be recruited from patients scheduled to undergo heart surgery at Wake Forest Baptist. The study will begin this month and will last for five years.
Co-researchers are Donald Bowden, Ph.D., Jorge Calles, M.D., Timothy Houle, Ph.D., Dixon Moody, M.D., and David Stump, Ph.D.
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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children’s Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of “America’s Best Hospitals” by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America’s Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and 4th in the Southeastern United States in revenues from its licensed intellectual property.