Risk factors of cerebral complications after cardiac surgery

OBJECTIVE. The authors defined the risk factors of cerebral complications after cadiosurgical operations. MATERIAL AND METHODS. The patients with ischemic heart disease who underwent coronary artery bypass grafting (CABG) were included in the first group (n=189) 132 (69,8 %) men and 57 (30,2 %) women aged 62,5 ± 8,3 years old. The patients who underwent reconstructive surgery of the heart valves were in the second group (n=50) and numbered 34 (68 %) men and 16 (32 %) women aged 63,1 ± 7,7 years old. The operations on valves were performed under conditions of extracorporeal circulation in the Center of Cardiosurgery and Interventional Cardiology of St. Petersburg Multidisciplinary Center. RESULTS. The research showed that the proportion of severe cerebral complications such as acute stroke and delirium was equal to 7,4 % in patients with coronary artery bypass grafting, while in group of patients with valvular pathology it numbered 14,0 %. The proportion of patients with delirium was 5,8 % in the first group and it consisted of 12 % in the second group. The number of patients with stroke was 1,58 % in the first group and it counted 2,0 % in the second group. Chronic cerebrovascular failure, stroke in the anamnesis, fibrillations of auricles and post-infarction cardiosclerosis were the leading risk factors of acute stroke development in early postoperative period. CONCLUSIONS. There was noted that such risk factors as postinfarction cardiosclerosis, stroke in the anamnesis and also the constrictive atherosclerosis of brachiocephalic trunk were associated with the group of patients who had cerebral complications after CABG operation. The proportion of patients with fibrillations of auricles (paroxysmal form) and a low left ventricular ejection fraction was higher in group of patients who underwent reconstructive surgery of the heart valves. The frequency of tobacco smoking was high among patients in both subgroups (77 % and 57,1 %).

early postoperative period, cerebral postoperative complications, risk factors

1. Бокерия Л. А. Отдалённые результаты аортокоронарного шунтирования у больных ИБС пожилого возраста // Анналы хирургии. 2012. № 2. С. 15-21.

2. Бокерия Л. А. Голухова Е. З., Ваничкин А. В. и др. Эхокардиографические корреляты при когнитивной дисфункции после кардиохирургических операций // Креативная кардиология. 2015. № 4. C. 13-24.

3. Бокерия Л. А. Сокольская Н. О., Копылова Н. С. и др. Эхокардиографические предикторы тяжести течения раннего послеоперационного периода у больных после хирургической реваскуляризации миокарда // Анестезиология и реаниматология. 2015. № 5. C. 8-11.

4. Крюков Н. Н., Николаевский Е. Н., Поляков В. П. Ишемическая болезнь сердца: (Современные аспекты клиники, диагностики, лечения, профилактики, медицинской реабилитации, экспертизы). Самара: Содружество, 2010. С. 472-505.

5. Кудашев И. Ф., Сигаев И. Ю. Предикторы неврологических осложнений у больных ишемической болезнью сердца в сочетании с атеросклеротическим поражением брахиоцефальных артерий, направляемых на операцию реваскуляризации миокарда // Клиническая физиология кровообращения. 2016. Т. 13, № 4. С. 192-196.

6. Лурье Г. О. Искусственное кровообращение. М.: Медицинское информационное агентство, 2002. 32 с.

7. Шабалова А. В., Джибладзе Д. Н., Казаков Э. Н. и др. Неврологические осложнения аортокоронарного шунтирования: виды, патогенез, профилактика // Нервные болезни. 2004. № 4. С. 9-13.

8. Шрадер Н. И., Шайбакова В. Л. Лихванцев В. В. и др. Неврологические осложнения аортокоронарного шунтирования // Журнал неврологии и психиатрии им. С. С. Корсакова. 2012. № 3. С. 76-81.

9. ACС/AHA Guidelines for the management of patients with ST-elevation myocardial infarction // Circulation. 2004. № 110. P. 82-292.

10. Anastasiadis K. Argiriadou H., Kosmidis M. et al. Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study // Heart. 2011. Vol. 97, № 13. P. 1082-1088.

11. Anderson R. E. Increased extracellular brain water after coronary artery bypass grafting is avoided by off-pump surgery // Cardiothorac. Vasc. Anesth. 1999. Vol. 13, № 6. P. 698-702.

12. Bendszus M. Reents W., Franke D. Brain damage after coronary artery bypass grafting // Arch. Neurol. 2002. Vol. 59, № 7. P. 1090-1095.

13. Bokeria L. A. Golukhova E. Z., Polunina A. G. Neural correlates of cognitive dysfunction after cardiac surgery // Brain Res. Rev. 2005. Vol. 50, № 2. P. 266-274.

14. Bucerius J. Gummert J. F., Borger M. A. et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients.// Ann Thorac Surg. 2003. Vol. 75, № 2. P. 472-478.

15. Delvin J. W., Fong J. J., Fraser G. L. et al. Delirium assessment in the critically ill // Intensive Care Med. 2007. Vol. 33, № 6. P. 929-940.

16. Frackowiak R. S. J. The pathophysiology of human cerebral ischemia: a new perspective obtained with positron emission tomography// Med. 1985. Vol. 57, № 2. P. 713-727.

17. Jensen B. O. Rasmussen L. S., Steinbruche D. A. Cognitive outcomes in elderly high-risk patients 1 year after off-pump versus on-pump coronary artery bypass grafting // Eur. J. Cardiothorac Surg. 2008. Vol. 34, № 5. P. 1016-1021.

18. Kam P. C. Calcroft R. M. Peri-operative stroke in general surgical patients // Anaesthesia. 1997. Vol. 52, № 9. P. 879-883.

19. Likosky D. S. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery // Stroke. 2003. Vol. 34, № 12. P. 2830-2834.

20. Taggart D. P. Westaby S. Neurological and cognitive disorders after coronary artery bypass grafting // Curr.Opin. Cardiol. 2001. Vol. 16, № 5. P. 271-276.