Clinical and anamnestic predictors of postoperative hypoxic and ischemic brain lesions and algorithms for their assessment of neurological support of сardiac surgery patients

Abstract

Modern technologies of cardiac surgery (CS) can significantly affect the structure of mortality, disability and quality of life of patients with critical ischemic disease, valvular heart disease, cardiomyopathies. In recent years, the overall mortality after CS with the use of artificial circulation (AC) is characterized by a decrease of 20–25 %, while the frequency of hypoxic-ischemic lesions (HIL) of the brain is almost unchanged and, even in older age groups increases. The aim of the study – to develop an algorithm for assessing the risk of hypoxic-ischemic brain lesions as components of neurological support of cardiac surgery patients. Materials and Methods. The study was performed on the clinical basis of the State Institution "Heart Institute of the Ministry of Health of Ukraine" with the use of primary materials on cardiac surgery using artificial circulation; involved two groups of patients, formed by the method of copy-pair (by characteristics: age, sex, type of intervention): in the first (n = 340 people) – patients with brain HIL after interventions, in the second (n = 340 people) – without brain HIL. The study used the results of routine neurological, instrumental and laboratory examinations at the stages of surgical treatment with the completion of a special "Card of expert assessment of neurological support of a patient with cardiac surgery." Results. The comparative intergroup analysis revealed reliable (p <0.05) CAF, their ranking according to the general informativeness was performed and 10 most informative were included in the forecasting algorithm, sequence of the risk assessment procedure and compile the appropriate tabular algorithm, to which, in descending order of informativeness, the most prognostic value features and the corresponding prognostic coefficients are introduced. The forecasting technology is quite simple and to achieve one of the prognostic amounts, which allows you to perform a personalized risk assessment with the simultaneous distribution (correlation) of the surveyed persons to one of the three risk groups. Conclusions. The diagnostic value and prognostic value of clinical and anamnestic predictors of risk of hypoxic-ischemic brain lesions were studied, their prognostic profile was compiled, the algorithm of risk personification was developed and three main prognostic adverse syndromes were identified: psychoneurological (encephalopathy, arterial hypertension, closed craniocerebral injuries in the anamnesis), vascular dysfunction (violation of cerebral autoregulation, decreased left ventricular ejection fraction, history of stroke, asymmetry of blood supply), cardiovascular disorders (atrial fibrillation, "silent" carotid artery stenosis, the presence of atheroma of the ascending aorta

Keywords

• hypoxic-ischemic brain lesions
• predictors
• cardiac surgery