Postoperative cognitive dysfunction after simultaneous carotid endarterectomy and coronary artery bypass grafting

Authors: Maleva O.V., Korotkevich A.A., Kukhareva I.N., Sosnina A.S., Ivanov S.V., Trubnikova O.A., Barbarash O.L.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-1-114-123

For citation: Maleva O.V., Korotkevich A.A., Kukhareva I.N., Sosnina A.S., Ivanov S.V., Trubnikova O.A., Barbarash O.L. Postoperative cognitive dysfunction after simultaneous carotid endarterectomy and coronary artery bypass grafting. Creative Cardiology. 2023; 17 (1): 114–23 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-114-123

Received / Accepted:  31.10.2022 / 15.03.2023

Keywords: simultaneous surgery carotid endarterectomy coronary artery bypass grafting postoperative cognitive dysfunction

Download
Full text:  

 

Abstract

The aim of the study – to conduct cognitive assessment of patients in the late postoperative period after simultaneous carotid endarterectomy and coronary artery bypass grafting.

Material and methods. The study included 26 patients; the mean age was 64.4 ± 7.3 years. Cognitive outcomes in these patients were assessed after simultaneous coronary artery bypass grafting and unilateral carotid endarterectomy. Extended psychometric testing was carried out using the software and hardware complex Status-PF. The cognitive ability indicators were measured upon admission to the hospital, in the early postoperative period – after 7.5 ± 3.8 days, and in the late postoperative period – after 15.6 ± 3.5 months. Postoperative cognitive dysfunction (POCD) was diagnosed in case of a 20% decline in memory, attention and neurodynamics indicators in 20% of completed tests.

Results. In the early postoperative period, the speed of visual-motor response increased by 9.5% (p = 0.02), whereas cognitive performance decreased by 4.7% compared to baseline (p = 0.03). In the late postoperative period, the speed of visual-motor response decreased by 10.5% compared to the early postoperative period (p = 0.02), thus reaching the baseline values. Moreover, compared to baseline, there was a 16% decrease in the number of errors made when performing the visual-motor response test (p = 0.04). The attention indicator increased by 20.9% compared to baseline (p = 0.008). The cognitive performance test revealed the following: a 4.7% decrease in response time (p = 0.009), a 22.9% increase in missed signals (p = 0.03), and a 14.8% decrease (p = 0.05) in the number of errors made compared to baseline.

Conclusion. Early POCD developed in 16 (61.5%) patients. In the late postoperative period, the number of patients with persistent POCD was 12 (60%), of which 7 (35%) patients had early POCD, and 5 (25%) patients developed persistent POCD without showing the signs of the early POCD.

References

  1. Sharma V., Deo S.V., Park S.J., Joyce L.D. Metaanalysis of staged versus combined carotid endarterectomy and coronary artery bypass grafting. Ann. Thorac. Surg. 2014; 97: 102–9. DOI: 10.1016/j.athoracsur.2013.07.091
  2. Akchurin R.S., Shiryaev A.A., Galyautdinov D.M., Vlasova E.E., Vasiliyev V.P., Ismagilov B.R., Balakhonova T.V. Short-term results of synchronous coronary artery bypass grafting and carotid endarterectomy. Russian Journal of Cardiology and Cardiovascular Surgery. 2017; 6: 4–8 (in Russ.). DOI: 10.17116/kardio20171064-8
  3. Khorev N.G., Yermolin P.A., Sokolov A.V., Kosoukhov A.P., Duda A.I., Konkova V.O., Shoikhet Ya.N. Surgical treatment of patients with combined atherosclerotic disease of carotid and coronary arteries. Bulletin of Medical Science. 2018; 1: 61–7 (in Russ.).
  4. Novitskaya-Usenko L.V. Post-operative cognitive dysfunction in an anesthesiologist’s practice. Emergency Medicine. 2017; 4: 9–15 (in Russ.). DOI: 10.22141/2224-0586.4.83.2017.107418
  5. Malyshok D.E., Savinceva A.I., Karpova A.S., Kuzina E.E., Evtukhov S.I., Balandina E.V. et al. The structure of postoperative cerebral dysfunction in simultaneous coronary bypass surgery and carotid endarterectomy. Russian Military Medical Academy Reports. 2019; 3: 212 (in Russ.). DOI: 10.17816/rmmar26214
  6. Selnes O.A., Gottesman R.F., Grega M.A. Baumgartner W.A., Zeger S.L., McKhann G.M. et al. Cognitive and neurologic outcomes after coronary artery bypass surgery. N. Engl. J. Med. 2012; 19; 250–7. DOI: 10.1056/NEJMra1100109
  7. Maleva O.V., Trubnikova O.A., Kukharevа I.N., Syrova I.D., Solodukhin A.V., Barbarash O.L. et al. Changes in cognitive status of patients undergoing simultaneous coronary artery bypass grafting and carotid endarterectomy. Russian Journal of Thoracic and Cardiovascular Surgery. 2018; 4: 317–24 (in Russ.). DOI: 10.24022/0236-2791- 2018-60-4-317-324
  8. Maleva O.V., Trubnikova O.A., Syrova I.D., Golovin A.A., Barbarash O.L., Barbarash L.S. et al. Early neurological outcomes after simultaneous coronary artery bypass surgery and carotid endarterectomy. Russian Journal of Cardiology and Cardiovascular Surgery. 2019: 5; 386–94 (in Russ.). DOI: 10.17116/kardio201912051386
  9. Vinogradov R.A., Timchenko L.V., Torgashova A.N., Bondarovich K.A., Kаpran T.I., Seledtsov V.V. et al. Dynamics of highger mental function in patients with obliterating lesions of internal carotid arteries in surgical brain revascularization. Sklifosovsky Journal of Emergency Medical Care. 2017; 221–7 (in Russ.). DOI: 10.23934/2223- 9022-2017-6-3-221-227
  10. Schröder J., Heinze M., Günther M., Cheng B., Nickel A., Schröder T. et al. Dynamics of brain perfusion and cognitive performance in revascularization of carotid artery stenosis. Neuroimage Clinical. 2019; 22: 101779. DOI: 10.1016/j.nicl.2019.101779
  11. Relander K., Hietanen M., Nuotio K., IjКs P., Tikkala I., Saimanen E. et al. Cognitive dysfunction and mortality after carotid endarterectomy. Front. Neurol. 2021; 11: 593719. DOI: 10.3389/fneur.2020.593719
  12. Tarasova I.V., Trubnikova O.A., Barbarash O.L., Barbarash L.S. EEG changes in patients with early and long-term postoperative cognitive dysfunction after on-pump coronary artery bypass surgery. Neurological Journal. 2017; 22 (3): 136–41 (in Russ.). DOI 10.18821/1560-9545- 2017-22-3-136-141

About Authors

  • Olga V. Maleva, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Aleksey A. Korotkevich, Junior Researcher, Radiologist; ORCID
  • Irina N. Kukhareva, Cand. Med. Sci., Senior Researcher, Neurologist; ORCID
  • Anastasiya S. Sosnina, Cand. Med. Sci., Researcher; ORCID
  • Sergey V. Ivanov, Dr. Med. Sci., Leading Researcher, Cardiovascular Surgeon; ORCID
  • Olga A. Trubnikova, Dr. Med. Sci., Head of the Laboratory, Cardiologist; ORCID
  • Olga L. Barbarash, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery