Posthypoxic encephalopathy in patients undergoing coronary artery bypass surgery: clinical, neuropsychological, and neuroimaging aspects

Posthypoxic encephalopathy is a frequent complication after coronary artery bypass surgery (CABG), which includes stroke, early postoperative delirium, and postoperative cognitive dysfunction (PCD). The more pronounced prevalence and severity of the latter during surgery using extracorporeal circulation are currently being discussed.Objective: to analyze various types of cerebral dysfunction in patients undergoing CABG and to determine the role of perioperative factors in its development.Patients and methods. The investigation enrolled 53 patients who had undergone elective CABG for coronary heart disease. Group 1 included 20 patients who had undergone beating-heart surgery; Group 2 comprised 33 patients, in whom CABG had been performed using extracorporeal circulation (ECC). Neuropsychological testing and brain magnetic resonance imaging (MRI) (structural and functional techniques) were carried out.Results and discussion. Posthypoxic encephalopathy was diagnosed in 10 and 67% of patients in Group 1 and 2, respectively (p=0.05); these were precisely all the three types of brain dysfunction which were observed in Group 2 patients. Factors, such as over 70 years of age; median level of education; smoking; body mass index >30 kg/m2 ; ejection fraction <50%; class III effort angina; >210-min surgery duration; >55-min aortic ligation; and >115-min ECC, showed a statistically significant association with the onset of PCD (p<0.05). In Group 2, MRI revealed a weaker positive functional relationship of the medial prefrontal cortex with the posterior cingulate gyrus (<0.005); 18% of patients were found to have acute ischemic zones.Conclusion. Surgical myocardial revascularization using ECC is associated with a greater likelihood of PCD than beating-heart CABG. The factors that favored the development of PCD, such as increased age, low preoperative cognitive status, smoking, and long-term use of ECC, were identified when applying ECC.

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Beating-heart coronary artery bypass surgery with the help of mini extracorporeal circulation for very high-risk patients

Perfusion ◽

10.1177/0267659110395650 ◽

2011 ◽

Vol 26 (2) ◽

pp. 123-131 ◽

Cited By ~ 13

Author(s):

Emmanuel Munos ◽

Joachim Calderon ◽

Xavier Pillois ◽

Stéphane Lafitte ◽

Alexandre Ouattara ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Coronary Artery Bypass ◽

Extracorporeal Circulation ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Beating Heart ◽

Risk Patients ◽

Very High

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Factors for the development of persistent postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery under extracorporeal circulation

Terapevticheskii arkhiv ◽

10.17116/terarkh201789941-47 ◽

2017 ◽

Vol 89 (9) ◽

pp. 41-47 ◽

Cited By ~ 3

Author(s):

O A Trubnikova ◽

I V Tarasova ◽

O V Maleva ◽

E S Kagan ◽

O L Barbarash ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Treatment Regimen ◽

Cognitive Dysfunction ◽

Extracorporeal Circulation ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Postoperative Cognitive Dysfunction ◽

Cognitive Status

Aim. To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC). Subjects and methods. 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3—5 days before, 7—14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD. Results. It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery. Conclusion. The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.

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Frontal Planar QRS/T Angle Can Be a Prognostic Factor in the Early Postoperative Period of Patients Undergoing Coronary Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.2014440 ◽

2015 ◽

Vol 17 (6) ◽

pp. 288 ◽

Cited By ~ 1

Author(s):

Kubilay Karabacak ◽

Murat Celik ◽

Yalcin Gokoglan ◽

Murat Kadan ◽

Erkan Kaya ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Postoperative Period ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Early Postoperative Period ◽

Absolute Difference ◽

Group 2 ◽

Group 1

Background: Wide QRS/T angle reflects the ventricular repolarization heterogeneity and has been found in association with cardiac morbidity and mortality in various study populations. However, literature data about the availability of QRS/T angle in patients undergoing cardiac surgery has not yet been available.Methods: A total of 157 patients who underwent isolated coronary artery bypass surgery were included in this study. A preoperative 12-lead ECG was obtained one day before surgical procedure. The absolute difference between the frontal QRS wave axes and T-wave axes was defined as frontal planar QRS/T angle. Afterwards, patients were divided into two groups according to their frontal planar QRS/T angle (the cut-off value as 90�).Results: Group 1 consisted of 109 patients with frontal planar QRS/T angle of <90, and the remaining 48 patients with frontal planar QRS/T angle 90 were placed into group 2. Mean EuroSCORE was much higher in group 2. There were significant differences for positive inotropic agent usage (27.5% for group 1 versus 58.3% for group 2, P < .001) and the prevalence of postoperative atrial fibrillation (11.9% for group 1 versus 31.2% for group 2, P = .004) between the two groups. In multivariate logistic regression analysis, used to determine the independent predictors of positive inotropic usage in the early postoperative period, only frontal planar QRS/T angle (OR: 0.989, 95% CI: 0.981-0.997, P = .008) and EuroSCORE (OR: 0.792, 95% CI: 0.646-0.971, P = .025) were found to be statistically significant.Conclusion: We found that frontal planar QRS/T angle might be an important preoperative parameter in predicting the need for inotropic drugs in the early postoperative period following coronary artery bypass surgery.

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