Neuroprotection in cardiosurgery

Abstract

Acute stroke is one of the most important complications of corоnary artery bypass grafting surgery (CABG) and valve replacement in the setting of assisted circulation. Therefore the cerebralprotection becomes the crucial part of preoperative care. We performed prospective randomized controlled trial to estimate theefficacy of cytoflavin in 103 patients (94 men, 9 women) withischemic heart disease (ICD) and acquired valve disease whoundergone CABG and valve replacement surgery. The patientswere divided into 4 groups. Group 1 (main) consisted of 32 patients with ICD (mean age 55.77.9 years) who underwent CABGand received 20 ml of cytoflavin i.v. in 3 consecutive days beforeand 3 days after surgery. Group 2 (control) included 40 patientswith ICD (mean age 48.212.6 years) and CABG without cytoflavin. Thirteen patients with valve disease (mean age 53.18.4years) were randomized in Group 3 (main); they underwentvalve replacement and were treated with cytoflavin using thesame regimen (20 ml i.v. in 3 days before and 3 days after surgery). Group 4 (control) was comprised of 18 patients with valvedisease (mean age 48.212.0 years) and surgery without cerebralprotection with cytoflavin. One month after the intervention significant improvement (p0.05) was observed in Group 1 vs.Group 2 in the dynamic modality of cognitive performance,recent memory and long-term memory, and clear trend toimprovement in the same variables in Group 3 vs. Group 4.Moreover, in Group 2 (CABG without treatment) significantdeterioration was observed in long-term memory (p=0.028),along with the distinct trend towards worsening in Group 4 inrecent and long-term memory. As an effective antioxidant, cytoflavin renders reliable neuroprotective effect in patients whоunderwent CABG in the setting of assisted circulation andimproves cognitive functioning and emotional well-being. Cytoflavin ameliorates absolute characteristics of long-term andrecent memory in patients after valve replacement surgery. Cytoflavin improves absolute parameters of cognitive evoked potentials (P300) decreasing the latency and increasing the amplitude inpatients after CABG and valve replacement. Cytoflavin isrecommended for use in patients with ICD and acquired valvedisease who underwent CABG and valve replacement in the setting of assisted circulation.

Keywords

• coronary artery bypass grafting surgery
• valve replacement
• cerebral protection