Early Neurological Complications after Cardiac/Aortic Surgery with Cardiopulmonary Bypass: Incidence and Risk Factors

2021 ◽  
Vol 104 (7) ◽  
pp. 1060-1066
Keyword(s):  
Cardiopulmonary Bypass ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Artery Bypass ◽  
Aortic Surgery ◽  
Neurological Complications ◽  
Serum Lactate ◽  
Valve Surgery ◽  
History Of ◽  
Bypass Technique

Objective: To examine the incidence and risk factors of early neurological complications after cardiac or aortic surgery using cardiopulmonary bypass technique in King Chulalongkorn Memorial Hospital, Thailand. Materials and Methods: The present study was a retrospective cohort study. Clinical data of adult patients that underwent cardiac or aortic surgery using cardiopulmonary bypass technique in 2018 were reviewed from the electronic medical record in the authors’ center. Results: Early postoperative neurological complications occurred in 33 (8.3%) of the 400 patients. Twenty of them (60.6%) had non-specific encephalopathy, three (9.1%) had hypoxic-ischemic encephalopathy, five (15.2%) had provoked seizure, four (12.1%) had cerebral infarction, and one (3.0%) had intracranial hemorrhage. Associated clinical factors included history of essential hypertension [adjusted odds ratio 3.448 (95% CI 1.266 to 9.391)], combined coronary artery bypass grafting and valve surgery [adjusted odds ratio 4.759 (95% CI 1.182 to 19.170)], multi-valve surgery [adjusted odds ratio 5.201 (95% CI 1.227 to 22.049)], aortic surgery [adjusted odds ratio 17.260 (95% CI 4.168 to 71.468)], higher midazolam dosage [adjusted odds ratio 1.009 (95% CI 1.002 to 1.015)], higher serum lactate prior to discontinuing cardiopulmonary bypass [adjusted odds ratio 1.263 (95% CI 1.093 to 1.460)], and presence of intraoperative intra-aortic balloon pump use [adjusted odds ratio 6.160 (95% CI 1.883 to 20.150)]. Conclusion: Early postoperative neurological complications rate of cardiac or aortic surgery using cardiopulmonary bypass technique in the present study settings was 8.3%. Preoperative and intraoperative clinical factors associated with such complications were the history of essential hypertension, the type of surgery such as combined coronary artery bypass grafting and valve surgery, multi-valve surgery, and aortic surgery, the higher midazolam dosage, the higher serum lactate prior to discontinuing cardiopulmonary bypass, and the presence of intraoperative intra-aortic balloon pump use. Keywords: Cardiac surgery; Aortic surgery; Cardiopulmonary bypass; Postoperative neurological complications; Encephalopath

PREDICTORS OF NEUROLOGICAL COMPLICATIONS AFTER CARDIAC SURGICAL INTERVENTIONS IN OLDERY PATIENTS

2020 ◽  
pp. 319-324
Author(s):  
О. В. Каменская ◽  
А. С. Клинкова ◽  
В. В. Ломиворотов ◽  
В. А. Шмырев ◽  
А. М. Чернявский
Keyword(s):  
Intraoperative Monitoring ◽  
Cerebral Oxygenation ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Surgical Interventions ◽  
Increased Risk ◽  
History Of ◽  
Left And Right

Для выявления предикторов неврологических осложнений в госпитальный период после коронарного шунтирования (КШ) проанализированы данные 92 больных 70 лет и старше с ИБС. Интраоперационно проведен мониторинг церебральной оксигенации ( rSO , %). На этапе вводной анестезии средний уровень rSO по правому и левому полушариям составлял 64-65% без значительных изменений во время операции. Снижение rSO во время искусственного кровообращения (ИК) связано с увеличением риска развития неврологических осложнений в раннем послеоперационном периоде. При снижении rSO во время ИК на 20% и более относительно исходных значений по левому и правому полушариям риск неблагоприятных неврологических событий возрастает в 7 и 9 раз соответственно. Два и более инфаркта миокарда в анамнезе в 3 раза увеличивают риск неврологических осложнений после КШ. To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation ( rSO , %) was carried out. At the stage of induction anesthesia, the average level of rSO for left and right hemispheres was 64-65 % without significant changes during the operation. A decrease in rSO during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO by 20 % or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery

2018 ◽  
Vol 129 (3) ◽  
pp. 440-447 ◽  
Author(s):  
Louise Y. Sun ◽  
Amy M. Chung ◽  
Michael E. Farkouh ◽  
Sean van Diepen ◽  
Jesse Weinberger ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Bypass Graft ◽  
Perioperative Stroke ◽  
Intraoperative Hypotension ◽  
Tertiary Center

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Stroke is a leading cause of morbidity, mortality, and disability in patients undergoing cardiac surgery. Identifying modifiable perioperative stroke risk factors may lead to improved patient outcomes. The association between the severity and duration of intraoperative hypotension and postoperative stroke in patients undergoing cardiac surgery was evaluated. Methods A retrospective cohort study was conducted of adult patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary center between November 1, 2009, and March 31, 2015. The primary outcome was postoperative ischemic stroke. Intraoperative hypotension was defined as the number of minutes spent within mean arterial pressure bands of less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after cardiopulmonary bypass. The association between stroke and hypotension was examined by using logistic regression with propensity score adjustment. Results Among the 7,457 patients included in this analysis, 111 (1.5%) had a confirmed postoperative diagnosis of stroke. Stroke was strongly associated with sustained mean arterial pressure of less than 64 mmHg during cardiopulmonary bypass (adjusted odds ratio 1.13; 95% CI, 1.05 to 1.21 for every 10 min of mean arterial pressure between 55 and 64 mmHg; adjusted odds ratio 1.16; 95% CI, 1.08 to 1.23 for every 10 min of mean arterial pressure less than 55 mmHg). Other factors that were independently associated with stroke were older age, hypertension, combined coronary artery bypass graft/valve surgery, emergent operative status, prolonged cardiopulmonary bypass duration, and postoperative new-onset atrial fibrillation. Conclusions Hypotension is a potentially modifiable risk factor for perioperative stroke. The study’s findings suggest that mean arterial pressure may be an important intraoperative therapeutic hemodynamic target to reduce the incidence of stroke in patients undergoing cardiopulmonary bypass.

scholarly journals Relationship between Periodontitis and Glaucoma: A Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Soo Hwan Byun ◽  
Dae Myoung Yoo ◽  
Minwook Chang ◽  
Hyo Geun Choi ◽  
Seok Jin Hong
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Epidemiology Study ◽  
Chi Square ◽  
Cross Sectional ◽  
History Of ◽  
And Control

The objective of this cross-sectional study was to evaluate the association between periodontitis and glaucoma. This prospective cohort study used epidemiological data from the Korean Genome and Epidemiology Study performed between 2004 and 2016. Among 173,209 participants, 9572 patients with periodontitis and 115,332 controls (nonperiodontitis) were selected. We analysed the history of glaucoma in periodontitis and control participants. The participants were interviewed regarding their history of hypertension, diabetes mellitus, hyperlipidaemia, periodontitis, glaucoma, smoking, and alcohol consumption by trained interviewers. A logistic regression model was created to analyse the odds ratio of having a history of glaucoma among patients with periodontitis. Two-tailed analyses using chi-square and independent t-tests were used for statistical analysis. The adjusted odds ratio of periodontitis as a risk factor for glaucoma was 3.44 (95% confidence interval = 2.99–3.97, p < 0.001 ). This study demonstrated that glaucoma was associated with periodontitis.

scholarly journals Association Study between the Polymorphisms of Matrix Metalloproteinase (MMP) Genes and Idiopathic Recurrent Pregnancy Loss

Genes ◽  
2019 ◽  
Vol 10 (5) ◽  
pp. 347 ◽  
Author(s):  
Han Sung Park ◽  
Ki Han Ko ◽  
Jung Oh Kim ◽  
Hui Jeong An ◽  
Young Ran Kim ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Pregnancy Loss ◽  
Adjusted Odds Ratio ◽  
Recurrent Pregnancy Loss ◽  
Proteolytic Enzymes ◽  
Nucleotide Polymorphisms ◽  
Genotype Combination ◽  
History Of ◽  
Consecutive Pregnancy

Recurrent pregnancy loss (RPL) refers to two or more consecutive pregnancy losses. It is estimated that fewer than 5% of women experience RPL. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that play important roles in providing a safe and conducive environment for the stable development of the fetus. In this case-control study, we evaluated the associations between RPL and single nucleotide polymorphisms (SNPs) in MMP-8 and MMP-27. We recruited 375 Korean women with a history of RPL and 240 ethnically-matched healthy parous controls, and we performed genotyping for the MMP-8 rs2509013 C>T, MMP-8 rs11225395 G>A, and MMP-27 rs3809017 T>C polymorphisms. All SNPs were genotyped via the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) assay. In the genotype frequency analyses, the TT genotype of the MMP-8 rs2509013 C>T (age-adjusted odds ratio, 0.415; 95% confidence interval, 0.257–0.671; P = 0.0003) and TC genotype of MMP-27 rs3809017 T>C (age-adjusted odds ratio, 0.681; 95% confidence interval, 0.483–0.961; P = 0.029) were associated with decreased RPL susceptibility. Moreover, these trends were maintained in the haplotype and genotype combination analyses. Interestingly, amongst the RPL patients, higher levels of homocysteine (P = 0.042) and uric acid (P = 0.046) were associated with MMP-27 rs3809017 T>C. In conclusion, the two polymorphisms of MMP-8 and MMP-27 were significantly associated with RPL risk, both individually and in combination. Therefore, these two polymorphisms are potential biomarkers for RPL susceptibility.

scholarly journals Heart surgery in patients on chronic dialysis

2013 ◽  
Vol 66 (1-2) ◽  
pp. 64-69 ◽  
Author(s):  
Dragana Unic-Stojanovic ◽  
Miroslav Milicic ◽  
Petar Vukovic ◽  
Srdjan Babic ◽  
Miomir Jovic
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Valve Surgery ◽  
Bypass Grafting ◽  
End Stage Renal Failure ◽  
End Stage

Introduction. Patients on dialysis for end-stage renal failure are subjected to cardiac surgery with increasing frequency. End-stage renal failure is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass. The aim of this study was to determine the impact of preoperative clinical status and operative variables on perioperative morbidity and mortality in hemodialysis dependent patients subjected to a cardiac surgery. Material and Methods. The following operative variables were examined: urgency, type and duration of surgery and duration of extracorporeal circulation. The study is a retrospective analysis of consecutive patients with end-stage renal failure dependent on maintenance hemodialysis who underwent cardiac surgery during four years. Results. The study included 46 patients. Operations performed included isolated coronary artery bypass grafting (CABG, n = 24), valve surgery alone (n = 6), and combined valve surgery or coronary artery bypass grafting and valve surgery (n = 16). The perioperative mortality rate was 13% with four fatal outcomes in patients who had undergone combined cardiac surgery. We found age > 70 years, preoperative New York Heart Association class IV, preoperative anemia, combined surgery and emergent surgery to be associated with a higher relative risk for perioperative death. Conclusion. Patients on dialysis have an increased morbidity and mortality following cardiac surgery; however, we believe that end-stage renal failure should not be regarded as a contraindication to cardiac surgery or cardiopulmonary bypass.

Effect of Immediate Resuscitation on Children With Submersion Injury

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 137-142
Author(s):  
Demetrios N. Kyriacou ◽  
Edgardo L. Arcinue ◽  
Corinne Peek ◽  
Jess F. Kraus
Keyword(s):  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neurological Impairment ◽  
Study Objective ◽  
Paramedical Personnel ◽  
Anoxic Encephalopathy ◽  
History Of ◽  
And Gender ◽  
Historical Accounts

Study objective. To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury. Design. A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio. Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California. Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 &lt; OR &lt; 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy. Conclusion. Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.

Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery

Perfusion ◽  
2011 ◽  
Vol 26 (6) ◽  
pp. 479-486 ◽  
Author(s):  
R Rimpiläinen ◽  
N Hautala ◽  
JK Koskenkari ◽  
J Rimpiläinen ◽  
PP Ohtonen ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Valve Surgery ◽  
Absolute Difference ◽  
Activation Markers ◽  
Markers Of Inflammation

Objectives: Minimized cardiopulmonary bypass (MCPB) circuits have been shown to reduce cerebral and retinal microembolisation during coronary artery bypass graft (CABG) surgery compared to conventional CPB (CCPB) circuits. Our aim was to evaluate whether the reduction of microembolisation is sustained in aortic valve surgery, as well as to evaluate the effects of MCPB on inflammatory, endothelial, and platelet activation markers. Material and methods: Patients were randomized to undergo aortic valve replacement (AVR), with or without CABG, with MPCB (n=20) or CCPB (n=20). After anaesthesia induction and termination of CPB, standardized digital retinal fluorescein angiography images were obtained on both eyes and analyzed in a blinded fashion. Blood samples were collected at eight time points until the third postoperative day. Results: Fewer patients in the MCPB group showed evidence of microembolic perfusion defects on postperfusion retinal fluorescein angiographs compared to the CCPB group (37% vs. 63%, absolute difference 26%, 95% CI -5% -51%, P = 0.194). Polymorphonuclear leukocyte (PMN) elastase and von Willebrand factor release were statistically significantly reduced in the MCPB group, but there were no significant differences in other markers of inflammation, coagulation or endothelial activation. A significantly higher three-fold increase in the amount of shed blood was collected to the cell saver with a higher rate of intraoperative platelet transfusion in the MCPB group compared to CCPB. Conclusions: The use of MCPB was associated statistically insignificantly with less retinal microemboli compared to CCPB. MCPB was complicated by excess bleeding and need for transfusion. The feasibility of MCPB techniques in valve surgery requires further studies.

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