Association between serum biomarkers and postoperative delirium after cardiac surgery

Background. In cardiac surgery, patients face an increased risk of developing postoperative delirium (POD) that is associated with poor outcomes. Neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have shown some promising results as potential tools for POD risk stratification, diagnosis, monitoring, and prognosis. Methods. Prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (CABG) and/ or valve procedures using cardiopulmonary bypass (CPB). The patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. The blood levels of NSE and GFAP were measured before and after surgery. The early POD was assessed by CAM-ICU criteria and patients were assigned to the POD group (with POD) or to the NPOD group (without POD) retrospectively. Results. The incidence of POD was 18.2%. After surgery, NSE significantly increased in the whole sample (p = 0.002). Comparing between groups, NSE significantly increased in the POD group after surgery (p = 0.042). ΔGFAP (before/after operation) for the whole sample was statistically significant (p = 0.022). There was a significant correlation between ΔGFAP and the lowest MAP during surgery in the POD group (p = 0.033). Conclusions. Our study demonstrated that NSE and GFAP are associated with early POD. An increase in NSE level during the perioperative period may be associated with subclinical neuronal damage. Serum GFAP levels show the damage of glial cells. Further studies are needed to find the factors influencing the individual limits of optimal MAP during surgery.

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Influence of Methylprednisolone on Levels of Neuron-Specific Enolase in Cardiac Surgery: A Corticosteroid Derivative to Decrease Possible Neuronal Damage

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2009.00842.x ◽

2009 ◽

Vol 24 (4) ◽

pp. 397-403 ◽

Cited By ~ 13

Author(s):

Tolga Demir ◽

Hale Demir ◽

Türkan Tansel ◽

Yusuf Kalko ◽

Emin Tireli ◽

...

Keyword(s):

Cardiac Surgery ◽

Neuronal Damage ◽

Neuron Specific Enolase

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Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

10.21203/rs.3.rs-588749/v1 ◽

2021 ◽

Author(s):

Petraglia Laura ◽

Conte Maddalena ◽

Comentale Giuseppe ◽

Cabaro Serena ◽

Campana Pasquale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Cardiac Surgery ◽

Epicardial Adipose Tissue ◽

Perioperative Period ◽

Postoperative Atrial Fibrillation ◽

Serum Samples ◽

Monocyte Chemoattractant Protein 1 ◽

Elective Cardiac Surgery ◽

Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

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Effect of concomitant diseases on the hemostasis system in the perioperative period of non-cardiac surgery

Лечащий врач ◽

10.51793/os.2021.24.11.012 ◽

2021 ◽

Author(s):

И.С. Пряхин ◽

С.С. Мурашко ◽

С.А. Бернс ◽

И.Н. Пасечник

Keyword(s):

Molecular Weight ◽

Cardiac Surgery ◽

Antithrombotic Therapy ◽

Perioperative Period ◽

Low Molecular Weight ◽

Clinical Factors ◽

Low Molecular Weight Heparins ◽

Global Test ◽

Thrombotic Risk ◽

Increased Risk

В данном исследовании изучалось влияние клинических факторов и антитромботической терапии на свертывающую систему крови пациентов в периоперационном периоде. В исследование включено 80 пациентов, которым проводилось плановое некардиальное хирургическое вмешательство. Лабораторный контроль осуществлялся с использованием рутинных методов исследования гемостаза (АЧТВ, МНО) и глобального теста исследования гемостаза (тест тромбодинамики). Использование теста тромбодинамики в данном исследовании оказалось более чувствительным методом по сравнению с рутинными тестами и позволило выявить клинические факторы, ассоциированные с гиперкоагуляционными состояниями и снижением эффективности низкомолекулярных гепаринов в послеоперационном периоде: возраст старше 60 лет, фибрилляция предсердий, хроническая ишемическая болезнь сердца, стентирование коронарных артерий в анамнезе, предшествующий прием антитромботической терапии до оперативного вмешательства. У больных с тромбозом глубоких вен нижних конечностей отмечалась гиперкоагуляция в первые сутки после проведения операции по сравнению с остальными пациентами. Использование теста тромбодинамики за сутки до оперативного вмешательства позволило спрогнозировать увеличение объема интраоперационной кровопотери. Назначение периоперационной мост-терапии низкомолекулярными гепаринами у больных с высоким тромботическим риском достоверно ассоциировалось с увеличением трансфузии эритромассы практически в 2 раза по сравнению с остальными пациентами и было связано с повышением риска геморрагических осложнений. Результаты исследования показали, что тест тромбодинамики потенциально может быть применен в дальнейших исследованиях с целью персонификации ведения пациентов в периоперационном периоде при некардиальной хирургии, а также способен прогнозировать возникновение геморрагических и тромботических осложнений. This study examined the effect of clinical factors and antithrombotic therapy on the blood coagulation system of patients in the perioperative period. The study included 80 patients who underwent elective noncardiac surgery. Laboratory control of hemostasis was carried out using routine tests for studying hemostasis (APTT, INR) and a global test for hemostasis (thrombodynamics test). Usage of the thrombodynamics test in this study was more sensitive compared to routine tests and made it possible to identify clinical factors associated with hypercoagulable states and «decreasing in the effectiveness» of low molecular weight heparins in the postoperative period. These factors are: age over 60 years, chronic ischemic heart disease, a history of coronary artery stenting, prior antithrombotic therapy before surgery. Hypercoagulability was found on the first day after surgery in patients with deep vein thrombosis of the lower extremities compared to other patients. The use of a thrombodynamics test a day before surgery allowed to predict an increase of intraoperative blood loss volume. Perioperative bridge therapy with low molecular weight heparins in high thrombotic risk patients was significantly associated with an increase in packed red blood cells transfusion of almost two times compared with other patients and is associated with an increased risk of hemorrhagic complications. The results of the study showed that thrombodynamics test can potentially be used further with the aim of personalizing patients’ management in the non-cardiac surgery perioperative period. It also helps to predict the occurrence of hemorrhagic and thrombotic complications.

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Postoperative Delirium in Patients with Chronic Obstructive Pulmonary Disease after Coronary Artery Bypass Grafting

Medicina ◽

10.3390/medicina56070342 ◽

2020 ◽

Vol 56 (7) ◽

pp. 342

Author(s):

Aleksandra Szylińska ◽

Iwona Rotter ◽

Mariusz Listewnik ◽

Kacper Lechowicz ◽

Mirosław Brykczyński ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Cardiac Surgery ◽

Pulmonary Disease ◽

Postoperative Delirium ◽

Artery Bypass ◽

Chronic Obstructive ◽

Bypass Grafting ◽

Obstructive Pulmonary Disease ◽

Probability Of Survival ◽

Copd Patients

Background and Objectives: The incidence of postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) is unclear. It seems that postoperative respiratory problems that may occur in COPD patients, including prolonged mechanical ventilation or respiratory-tract infections, may contribute to the development of delirium. The aim of the study was to identify a relationship between COPD and the occurrence of delirium after cardiac surgery and the impact of these combined disorders on postoperative mortality. Materials and Methods: We performed an analysis of data collected from 4151 patients undergoing isolated coronary artery bypass grafting (CABG) in a tertiary cardiac-surgery center between 2012 and 2018. We included patients with a clinical diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The primary endpoint was postoperative delirium; Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) was used for delirium assessment. Results: Final analysis included 283 patients with COPD, out of which 65 (22.97%) were diagnosed with POD. Delirious COPD patients had longer intubation time (p = 0.007), more often required reintubation (p = 0.019), had significantly higher levels of C-reactive protein (CRP) three days after surgery (p = 0.009) and were more often diagnosed with pneumonia (p < 0.001). The CRP rise on day three correlated positively with the occurrence of postoperative pneumonia (r = 0.335, p = 0.005). The probability of survival after CABG was significantly lower in COPD patients with delirium (p < 0.001). Conclusions: The results of this study confirmed the relationship between chronic obstructive pulmonary disease and the incidence of delirium after cardiac surgery. The probability of survival in COPD patients undergoing CABG who developed postoperative delirium was significantly decreased.

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Inferior outcomes following cardiac surgery in patients with a functioning renal allograft

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa245 ◽

2020 ◽

Author(s):

Ibrahim T Fazmin ◽

Muhammad U Rafiq ◽

Samer Nashef ◽

Jason M Ali

Keyword(s):

Cardiac Surgery ◽

Renal Transplantation ◽

Renal Allograft ◽

Artery Bypass ◽

Perioperative Period ◽

Outcome Data ◽

Term Survival ◽

Logistic Euroscore ◽

Prolonged Length ◽

The Mean

Abstract OBJECTIVES Renal transplantation is an effective treatment for end-stage renal failure. The aim of this study was to evaluate outcomes for these patients undergoing cardiac surgery. METHODS A retrospective analysis identified patients with a functioning renal allograft at the time of surgery. A 2:1 propensity matching was performed. Patients were matched on: age, sex, left ventricle function, body mass index, preoperative creatinine, operation priority, operation category and logistic EuroSCORE. RESULTS Thirty-eight patients undergoing surgery with a functioning renal allograft were identified. The mean age was 62.4 years and 66% were male. A total of 44.7% underwent coronary artery bypass grafting and 26.3% underwent a single valve procedure. The mean logistic EuroSCORE was 10.65. The control population of 76 patients was well matched. Patients undergoing surgery following renal transplantation had a prolonged length of intensive care unit (3.19 vs 1.02 days, P < 0.001) and hospital stay (10.3 vs 7.17 days, P = 0.05). There was a higher in-hospital mortality (15.8% vs 1.3%, P = 0.0027). Longer-term survival on Kaplan–Meier analysis was also inferior (P < 0.001). One-year survival was 78.9% vs 96.1% and 5-year survival was 63.2% vs 90.8%. A further subpopulation of 11 patients with a failed renal allograft was identified and excluded from the main analysis; we report demographic and outcome data for them. CONCLUSIONS Patients with a functioning renal allograft are at higher risk of perioperative mortality and inferior long-term survival following cardiac surgery. Patients in this population should be appropriately informed at the time of consent and should be managed cautiously in the perioperative period with the aim of reducing morbidity and mortality.

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The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-020-01180-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Leerang Lim ◽

Karam Nam ◽

Seohee Lee ◽

Youn Joung Cho ◽

Chan-Woo Yeom ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Postoperative Delirium ◽

Artery Bypass ◽

Bypass Graft ◽

Cerebral Oximetry ◽

Artery Bypass Graft ◽

Off Pump ◽

Pump Coronary Artery Bypass ◽

The Relationship

Abstract Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

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PERIOPERACINIS MIOKARDO INFARKTAS

Sveikatos mokslai ◽

10.5200/sm-hs.2013.129 ◽

2013 ◽

Vol 23 (6) ◽

pp. 29-34

Author(s):

Andrius Macas ◽

Giedrė Bakšytė ◽

Laura Šilinskytė ◽

Jūratė Petrauskaitė

Keyword(s):

Myocardial Infarction ◽

Cardiac Surgery ◽

Oxygen Supply ◽

Plaque Rupture ◽

Perioperative Period ◽

Vascular Complication ◽

Early Postoperative Period ◽

Hospital Length Of Stay ◽

Perioperative Myocardial Infarction ◽

Risk Patients

Perioperative myocardial infarction (PMI) is defined as myocardial infarction (MI) during perioperative period (24-72 hours after non cardiac surgery). Worldwide, over 200 million adults have major non-cardiac surgery each year, and several million experience a major vascular complication (e.g.: nonfatal myocardial infarction). The prevalence of PMI for low risk patients without ischemic heart disease is from 0.3 to 3%, while for medium and high risk patients with coronary artery disease increases to 30%. It is believed that plaque rupture and myocardial oxygen supply-demand imbalance is the main reason of perioperative myocardial infarction. Mostly oxygen supply-demand imbalance predominates in the early postoperative period. Plaque rupture appears to be a more random event, distributed over the entire perioperative admission. Most patients with a perioperative MI do not experience ischemic symptoms, because of sedation and analgesia during surgery procedure. This is the reason why routine monitoring of troponin levels and electrocardiography in at-risk patients are needed after surgery to detect most MI. In 90% of cases troponin level inceases during the first 24 hours after surgery. Risk factors detection, serial troponin evaluation and specialised treatment can reduce hospital length of stay, treatment costs and PMI mortality.

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Device based prevention of neurological events in coronary artery bypass patients with calcified ascending aorta.

10.22541/au.163250079.92270536/v1 ◽

2021 ◽

Author(s):

Michal Szlapka ◽

Philipp Peitsmeyer ◽

Stefanie Halder ◽

Oliver Natho ◽

Michael Lass ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Ascending Aorta ◽

Interventional Treatment ◽

Increased Risk ◽

Coronary Artery Bypass Patients ◽

Calcified Aorta ◽

Neurologic Event

Patients with severely calcified aorta undergoing conventional cardiac surgery are at increased risk for postoperative neurologic deficits. Implementation of cerebroprotective devices may substantially reduce or even eliminate the risk of adverse neurologic event, thus enabling surgical therapy, especially when interventional treatment cannot be considered an alternative option.

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The effects of platelet inhibitors on blood use in cardiac surgery

Perfusion ◽

10.1191/0267659102pf532oa ◽

2002 ◽

Vol 17 (1) ◽

pp. 33-37 ◽

Cited By ~ 15

Author(s):

Leonard Y Lee ◽

William DeBois ◽

Karl H Krieger ◽

Leonard N Girardi ◽

Laura Russo ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bleeding Risk ◽

Platelet Inhibition ◽

Increased Risk ◽

Vessel Patency ◽

Balance Technique ◽

Coronary Syndromes

Platelet inhibition via glycoprotein (GP) IIb/IIIa receptor antagonists has greatly reduced the need for emergent cardiac surgery. However, this change has come at a cost to both the patient and the cardiac surgical team in terms of increased bleeding risk. Current guidelines for patients requiring coronary artery bypass surgery include: 1) cessation of GP IIb/IIIa inhibitor; 2) delay of surgery for up to 12 h if abciximab, tirofiban, or eptafibitide is used; 3) utilization of ultrafiltration via zero balance technique; 4) maintenance of standard heparin dosing despite elevated bleeding times; and 5) transfusion of platelets as needed, rather than prophylactically. These agents present cardiac surgery teams with increased risk during CABG, although overall risk may be diminished by the substantial benefits to patients with acute coronary syndromes and percutaneous interventions, i.e., reduced infarction rates and improved vessel patency. With judicious planning, urgent coronary artery bypass can be safely performed on patients who have been treated with GP IIb/IIIa receptor inhibitors.

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Preoperative Cognitive Impairment and Postoperative Delirium Predict Decline in Activities of Daily Living after Cardiac Surgery—A Prospective, Observational Cohort Study

Geriatrics ◽

10.3390/geriatrics5040069 ◽

2020 ◽

Vol 5 (4) ◽

pp. 69

Author(s):

Ulf Guenther ◽

Falk Hoffmann ◽

Oliver Dewald ◽

Ramy Malek ◽

Kathrin Brimmers ◽

...

Keyword(s):

Cardiac Surgery ◽

Cognitive Impairment ◽

Cognitive Function ◽

Daily Living ◽

Postoperative Delirium ◽

Functional Decline ◽

Preoperative Assessment ◽

Perioperative Period ◽

Subsequent Treatment ◽

Assessment Tools

Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; p < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; p < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); p = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); p = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.

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