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Asta L, Falco D, Benedetto U, Porreca A, Majri F, Angelini GD, Sensi S, Di Giammarco G. Stroke after Cardiac Surgery: A Risk Factor Analysis of 580,117 Patients from UK National Adult Cardiac Surgical Audit Cohort. J Pers Med 2024; 14:169. [PMID: 38392602 PMCID: PMC10890399 DOI: 10.3390/jpm14020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/07/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Cerebrovascular accident is the most ominous complication observed after cardiac surgery, carrying an increased risk of morbidity and mortality. Analysis of the problem shows its multidimensional nature. In this study, we aimed to identify major determinants among classic variables, either demographic, clinical or type of surgical procedure, based on the analysis of a large dataset of 580,117 patients from the UK National Adult Cardiac Surgical Audit (NACSA). For this purpose, univariate and multivariate logistic regression models were utilized to determine associations between predictors and dependent variable (Stroke after cardiac surgery). Odds ratios (ORs) and 95% confidence intervals (CIs) were constructed for each independent variable. Statistical analysis allows us to confirm with greater certainty the predictive value of some variables such as age, gender, diabetes mellitus (diabetes treated with insulin OR = 1.37, 95%CI = 1.23-1.53), and systemic arterial hypertension (OR = 1.11, 95%CI = 1.05-1.16);, to emphasize the role of preoperative atrial fibrillation (OR = 1.10, 95%CI = 1.03-1.16) extracardiac arteriopathy (OR = 1.70, 95%CI = 1.58-1.82), and previous cerebral vascular accident (OR 1.71, 95%CI = 1.6-1.9), and to reappraise others like smoking status (crude OR = 1.00, 95%CI = 0.93-1.07 for current smokers) or BMI (OR = 0.98, 95%CI = 0.97-0.98). This could allow for better preoperative risk stratification. In addition, identifying those surgical procedures (for example thoracic aortic surgery associated with a crude OR of 3.72 and 95%CI = 3.53-3.93) burdened by a high risk of neurological complications may help broaden the field of preventive and protective techniques.
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Affiliation(s)
- Laura Asta
- Department of Cardiac Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Daniele Falco
- Division of Cardiac Surgery, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences, Cardiac Surgery Department, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy
| | - Fatma Majri
- Department of Protection and Prevention, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Gianni D Angelini
- Department of Cardiac Surgery, University of Bristol, Bristol BS8 1QU, UK
| | - Stefano Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, Cardiac Surgery Department, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy
| | - Gabriele Di Giammarco
- Department of Neuroscience, Imaging and Clinical Sciences, Cardiac Surgery Department, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy
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Bozhinovska M, Jenko M, Stupica GT, Klokočovnik T, Kšela J, Jelenc M, Podbregar M, Fabjan A, Šoštarič M. Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study. J Cardiothorac Surg 2021; 16:142. [PMID: 34030698 PMCID: PMC8142614 DOI: 10.1186/s13019-021-01509-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. Methods Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure. Results A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). Conclusion There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. Trial registry number clinicaltrials.gov, NCT02697786 14. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01509-8.
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Affiliation(s)
- Marija Bozhinovska
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Matej Jenko
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Gordana Taleska Stupica
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia
| | - Tomislav Klokočovnik
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Juš Kšela
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Jelenc
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Podbregar
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Department of Internal Intensive Medicine, General and Teaching Hospital, Celje, Slovenia
| | - Andrej Fabjan
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.,Clinical Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Šoštarič
- Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia. .,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
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Tang S, Huang W, Zhang K, Chen W, Xie T. Comparison of effects of propofol versus sevoflurane for patients undergoing cardiopulmonary bypass cardiac surgery. Pak J Med Sci 2019; 35:1072-1075. [PMID: 31372145 PMCID: PMC6659056 DOI: 10.12669/pjms.35.4.1279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the effects of propofol versus sevoflurane on the outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods A total of 110 patients undergoing cardiac surgery with CPB in our hospital from January 2015 to June 2017 were randomly divided into 2 groups (n=55): Group A, in which anesthesia was maintained with sevoflurane, and Group B, in which anesthesia was maintained with propofol. The MMSE score before and after operation, perioperative laboratory index, incidence of postoperative cognitive dysfunction (POCD) and incidence of adverse events between the two groups were compared. Results The MMSE score was significantly higher in Group B than in Group A after anesthesia (p<0.05). Serum levels of the brain injury markers neuron-specific enolase, S100β and matrix metalloproteinase 9 were significantly lower in Group B than in Group A (p<0.05). POCD incidence at 12 hour and 24 hour after operation was significantly lower in Group B than in Group A (p<0.05). There were no significant differences in the incidence of low cardiac output and thoracotomy bleeding between two groups. Conclusion Compared with sevoflurane, the use of propofol during cardiac surgery with CPB can efficiently improve postoperative cognitive function without increasing the risk of adverse reactions.
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Affiliation(s)
- Shaoqun Tang
- Shaoqun Tang, Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Wei Huang
- Wei Huang, Department of Neurology, Taihe Hospital Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Kun Zhang
- Kun Zhang, Department of Anesthesiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, 434020, P.R. China
| | - Wei Chen
- Wei Chen, Department of Anesthesiology, The first people's hospital of Jingzhou, The first Clinical Medical College, Yangtze University, Jingzhou, Hubei, 434020, P.R. China
| | - Tao Xie
- Tao Xie, Department of Anesthesiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, 434020, P.R. China
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Kotlinska-Hasiec E, Czajkowski M, Rzecki Z, Stadnik A, Olszewski K, Rybojad B, Dabrowski W. Disturbance in Venous Outflow From the Cerebral Circulation Intensifies the Release of Blood-Brain Barrier Injury Biomarkers in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2014; 28:328-35. [DOI: 10.1053/j.jvca.2013.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 02/06/2023]
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