Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery

Onur ŞEN; Okan YILDIZ

Journals / Koşuyolu Heart Journal / 2019 / Cilt: 22 - Sayı: 2

Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery

Erişkin Kalp Cerrahisinde Kardiyopulmoner Baypas Sırasındaki Beyin Perfüzyonu ile Mortalite Skorlarının Etkileşimi

Onur ŞEN

Okan YILDIZ

Journal: Koşuyolu Heart Journal
Issue: 2019 · Cilt: 22 - Sayı: 2
Pages: 79–84
Publication Date: 2019-08-15
DOI: —

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AI Summary & Key Takeaways

AI Insight

⚡ TL;DR(Too Long; Didn't Read)

It is now suggested that these changes can eventually be a good guide and predictor for the management of patients during preoperative and postoperative periods.

📌 3 Key Takeaways

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Objective & Hypothesis: Introduction: This study aims to investigate the correlation between cerebral perfusion changes and mortality rate in individuals undergoing adult cardiac surgery.

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Key Findings & Data:Patients and Methods: Between April 2018-August 2018, 91 adult individuals who underwent open heart surgery with cardiopulmonary bypass (CPB) were prospectively evaluated.

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Conclusion & Impact:It is now suggested that these changes can eventually be a good guide and predictor for the management of patients during preoperative and postoperative periods.

🔬Design:Research Article

📍Scope:2018 Verileri

⚙️Variables:Erişkin kalp cerrahisi · kardiyopulmoner baypas · serebral NIRS

Abstract

Introduction: This study aims to investigate the correlation between cerebral perfusion changes and mortality rate in individuals undergoing adult cardiac surgery. Patients and Methods: Between April 2018-August 2018, 91 adult individuals who underwent open heart surgery with cardiopulmonary bypass (CPB) were prospectively evaluated. Cerebral perfusion was monitored via near-infrared spectroscopy (NIRS). The NIRS values were recorded at four intervals: T0, just before CPB; T1, cooling period (time taken to reach targeted hypothermia); T2, warming period (time taken to reach normal body temperature); and T3, following minutes of termination of CPB. Euro Score II and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded for each individual. Results: The operations performed include coronary artery bypass surgery (n= 41, 45%), valvular surgery (n= 47, 51%), and coronary artery bypass combined with valvular surgery (n= 3, 4%). Median Euro Score II was calculated to be 1.1 (range 0.7-36.6), and median APACHE II score was calculated to be 6 (range 0-23). Mortality occurred in four individuals for whom the Euro Score II C index was 0.702 (confidence interval, 0.411- 0.993; p= 0.048) and APACHE-II score C index was 0.871 (confidence interval, 0.660-1; p= 0.010). During the operative period, cerebral NIRS values decreased during T3 period, and significant changes occurred at T0-T3 period, consequently leading to an increase in the APACHE-II scores and the prediction of mortality. Conclusion: The changes at NIRS values were related with higher mortality, morbidity, and predicting scores. It is now suggested that these changes can eventually be a good guide and predictor for the management of patients during preoperative and postoperative periods.

Özet

Giriş: Bu çalışmada erişkin kalp cerrahisi ameliyatları sırasındaki beyin perfüzyonu ile mortalite skorlarının etkileşimlerinin araştırılması amaçlandı. Hastalar ve Yöntem: Nisan 2018-Ağustos 2018 tarihleri arasında kliniğimizde kardiyopulmoner baypas (KPB) ile ameliyat edilecek erişkin hastalar çalışmaya dahil edildi (n= 91). Beyin perfüzyonunu belirlemek için “Near Infrared Spectroscopy (NIRS)” yöntemi kullanıldı. Ölçümler dört zaman aralığında yapıldı. T0: KPB öncesi, T1: soğuma periyodu, T2: ısınma periyodu, T3: KPB sonrası. Mortalite skorları olarak EuroSCORE II ve “Acute Physiology and Chronic Health Evaluation (APACHE)” II skoru değerleri her bir hasta için kaydedildi. Bulgular: Ameliyat verileri, koroner arter baypas cerrahisi (n= 41, %45), kapak ameliyatları (n= 47, %51), koroner arter baypas cerrahisi ve kapak ameliyatlarının birlikte uygulandığı hastalar (n= 3, %4) olarak saptandı. Ortalama Euroscore II 1.1 (0.7-36.6) ve ortalama APACHE II skoru 6 (0-23) bulundu. Ölüm gelişen dört hastada EuroSCORE II C indeksi 0.702 (Confidence interval 0.411-0.993, p= 0.048) ve APACHE II score C indeksi 0.871 (Confidence interval 0.660-1, p= 0.010) belirlendi. Ameliyat sırasında T3 dönemindeki NIRS ölçüm değerleri düşük bulunan ve T0-T3 periyodundaki NIRS değeri değişiklikleri anlamlı olan hastalarda APACHE II skoru ölçümlerinde anlamlı değişiklik saptandı. Sonuç: NIRS ölçümlerindeki değişiklikler, mortalite ve morbidite skorlama yöntemleri ölçümleriyle paralellik gösterir. Bu nedenle ameliyat öncesi ve sonrası dönemdeki hasta yönetimi açısından NIRS ölçümü iyi bir belirteçtir.

Keywords

Erişkin kalp cerrahisi kardiyopulmoner baypas serebral NIRS Adult cardiac surgery cardiopulmonary bypass cerebral NIRS

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Cite This Article

ŞEN, O., YILDIZ, O. (2019). Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery. Koşuyolu Heart Journal, Cilt: 22 - Sayı: 2, 79–84. https://ajindex.com/articles/63852

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