Predictors of short-term neurocognitive outcome following coronary revascularisation (CABG) depending on the use of cardiopulmonary bypass [Prediktori kratkoročnog neurokognitivnog ishoda nakon koronarne revaskularizacije (CABG) ovisno o upotrebi izvantjelesnog krvotoka]

Lazibat, Ines and Sutlić, Željko and Brkić, Kristina and Nevajda, Branimir and Šikić, Jozica and Havelka Meštrović, Ana (2012) Predictors of short-term neurocognitive outcome following coronary revascularisation (CABG) depending on the use of cardiopulmonary bypass [Prediktori kratkoročnog neurokognitivnog ishoda nakon koronarne revaskularizacije (CABG) ovisno o upotrebi izvantjelesnog krvotoka]. Collegium Antropologicum, 36 (3). pp. 827-833. ISSN 0350-6134

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Abstract

The purpose of our study was to investigate the association between perioperative cerebral microembolization, expressed as high-intensity transient signals (HITS) and postoperative dynamics of the neuromarker S100P in patients operated using cardiopulmonary bypass, and to assess their impact upon the neurocognitive function in the early postoperative stage. The study involved 62 consecutive male patients aged 60 or above, alls scheduled for elective aortocoronary bypass. The patients were recruited from two groups with respect to the use of CPB: on-pump group (CPB+, N = 30) and off-pump group (CPB-, N = 32). In all patients we performed intraoperative monitoring of cerebral haemodynamics using transcranial Doppler, with the goal of quantifying perioperative cerebral microembolization. The serum levels of the neuromarker S100l were measured immediately after surgery, and then 12, 24 and 48 hours after the surgery. Neurocognitive status was assessed before and after the surgery and in three cognitive domains. Results of the study have shown that with respect to the short-term postoperative neurocognitive outcome there is no significant difference between the on-pump and off-pump surgical technique of coronary revascularization'. Perioperative cerebral microembolization was significantly more pronounced in the on-pump group yet it did not affect early postoperative neurocognitive function, while the increase in the neuromarker S100beta serum level 48 hours after surgery may have prognostic value as a predictor of postoperative neurocognitive dysfunction.

Abstract in Croatian

Istraživanje je provedeno sa svrhom ispitivanja povezanosti perioperacijske cerebralne mikroembolizacije (HITS) i poslijeoperacijske dinamike neurobiljega S100b s primjenom izvantjelesnog krvotoka (CPB), te utvrđivanjem njihovog učinka na neurokognitivnu funkciju u ranom poslijeoperacijskom razdoblju. U ispitivanje su uključena 62 konsekutivna muška bolesnika starija od 60 godina predviđena za elektivnu operaciju aortokoronarnog premoštenja. Bolesnici su regrutirani iz dvije skupine s obzirom na uporabu CPB: on-pump skupina (CPB+, N=30) i off-pump skupina (CPB–, N=32). Kod svih ispitanika provedeno je intraoperacijsko monitoriranje cerebralne hemodinamike transkranijskim doplerom u cilju kvantificiranja perioperacijske cerebralne mikroembolizacije. Serumske razine neurobiljega S100b mjerene su prije operacije, neposredno nakon operacije te 12, 24 i 48 sati od operacije. Neurokognitivni status se ocjenjivao prije i poslijeoperacijski u tri kognitivne domene. Rezultati istraživanja pokazuju da nema značajne razlike između on-pump i off-pump kirurške tehnike koronarne revaskularizacije s aspekta kratkoročnog poslijeoperacijskog neurokognitivnog ishoda. Perioperacijska cerebralna mikroembolizacija značajno je izraženija uz primjenu izvantjelesnog krovotoka ali ne utječe na ranu poslijeoperacijsku neurokognitivnu funkciju, dok porast serumske razine neurobiljega S100b 48 sati nakon operacije može imati prognostičku vrijednost kao mogući prediktor poslijeoperacijske neurokognitivne disfunkcije.

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