Neuroprotection in cardiosurgery

Cover Page

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 cerebral protection becomes the crucial part of preoperative care. We performed prospective randomized controlled trial to estimate the efficacy of cytoflavin in 103 patients (94 men, 9 women) with ischemic heart disease (ICD) and acquired valve disease who undergone CABG and valve replacement surgery. The patients were divided into 4 groups. Group 1 (main) consisted of 32 patients with ICD (mean age 55.7±7.9 years) who underwent CABG and received 20 ml of cytoflavin i.v. in 3 consecutive days before and 3 days after surgery. Group 2 (control) included 40 patients with ICD (mean age 48.2±12.6 years) and CABG without cytoflavin. Thirteen patients with valve disease (mean age 53.1±8.4 years) were randomized in Group 3 (main); they underwent valve replacement and were treated with cytoflavin using the same regimen (20 ml i.v. in 3 days before and 3 days after surgery). Group 4 (control) was comprised of 18 patients with valve disease (mean age 48.2±12.0 years) and surgery without cerebral protection with cytoflavin. One month after the intervention significant improvement (p<0.05) was observed in Group 1 vs. Group 2 in the dynamic modality of cognitive performance, recent memory and long-term memory, and clear trend to improvement in the same variables in Group 3 vs. Group 4. Moreover, in Group 2 (CABG without treatment) significant deterioration was observed in long-term memory (p=0.028), along with the distinct trend towards worsening in Group 4 in recent and long-term memory. As an effective antioxidant, cytoflavin renders reliable neuroprotective effect in patients whо underwent CABG in the setting of assisted circulation and improves cognitive functioning and emotional well-being. Cytoflavin ameliorates absolute characteristics of long-term and recent memory in patients after valve replacement surgery. Cytoflavin improves absolute parameters of cognitive evoked potentials (P300) decreasing the latency and increasing the amplitude in patients after CABG and valve replacement. Cytoflavin is recommended for use in patients with ICD and acquired valve disease who underwent CABG and valve replacement in the setting of assisted circulation.

 

About the authors

Z. A. Suslina

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

L. A. Bokeria

Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

M. A. Piradov

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

A. I. Malashenkov

Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

N. A. Akhmadzhonuva

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

P. A. Fedin

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

Yu. V. Rodionova

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

O. Yu. Rebrova

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

M. V. Krotenkova

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

A. V. Lagutin

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

A. S. Klochkov

Research Center of Neurology, Russian Academy of Medical Sciences, Moscow

Email: platonova@neurology.ru
Russian Federation

References

  1. Бузиашвили Ю.И., Амбатьелло С.Г. Влияние искусственного кровообращения на состояние когнитивных функций у больных ишемической болезнью сердца. Журнал неврологии и психиатрии им. С.С. Корсакова 2005; 1: 30–35.
  2. Бокерия Л.А., Голухова Е.З., Полунина А.Г. Методы оценки неврологических исходов в кардиохирургии. Грудная и сердечно-сосудистая хирургия.
  3. Глозман Ж.М. Количественная оценка данных нейропсихологического обследования. М.: Центр лечебной педагогики, 1999: 26–29.
  4. Гнездицкий В.В. Вызванные потенциалы мозга в клинической практике. Таганрог: ТГРУ, 1997.
  5. Ивницкий Ю.Ю., Головко А.И., Сафронов Г.А. Янтарная кислота в системе средств метаболичесокой коррекции функционального состояния резистентности организма. СПб.: Лань, 1998.
  6. Коберская Н.Н. Когнитивный потенциал Р300. Неврологический журнал 2003: 6: 34.
  7. Корсакова Н.К., Московичюте Л.И. Клиническая нейропсихология. М.: Изд. центр «Академия», 2003: 74–80.
  8. Лурия А.Р. Основы нейропсихологии. М., 1973: 147–151.
  9. Сейидов В.Г. Сравнение результатов коронарного шунтирования в течение первого года после операции и консервативного лечения. Клиническая фармакология и терапия 2006; 15 (4): 78–81.
  10. Томас Ф. Неврологическая оценка и лечение больных после операции на сердце. Бюллетень НЦССХ им. Бакулева РАМН 2002; 3: 4.
  11. Шабалова А.В., Джибладзе Д.Н., Казаков Э.Н. Неврологические осложнение аортокоронарного шунтирования: виды, патогенез, профилактика. Атмосфера. Нервные болезни 2004; 4: 9–13.
  12. Шабалова А.В. Комплексная оценка особенностей церебральной гемодинамики, неврологического статуса и когнитивных функций у больных с атеросклеротическим поражением коронарМ ных артерий, требующим хирургической коррекции. Дисс. … канд. мед. наук, 2004.
  13. Шевченко Ю.Л., Михайленко А.А., Кузнецов А.Н., Ерофеев А.А. Кардиохирургическая агрессия и головной мозг. СПб.: Наука, 1997.
  14. Ancelin M.L., de Roquefeuil G. Exposure to anaesthetic agents, cognitive functioning, and depressive symptomalogy in the elerly. Br. J. Psychiatry 2001; 178: 102–111.
  15. Guy M., Mckhann M.D., Manga А., Grega R.N. Stroke and encephalohfthy after cardiac surgery an update. Stroke 2006; 37: 562–571.
  16. Madl C., Grimm G., Kramer L. et al. Cognitive brain function in non-demented patients with lowМgrade and highМgrade carotid artery stenosis. Eur. J. Clin. Invest. 1994; 24: 559–564.
  17. Mills S.A. Cerebral Injury and cardiac operations. Ann. Thorac. Surg. 1993; 56(86): 91150.
  18. Murkin J.M., Martzke J.S., Bucham A.M. et al. Cognitive and neurological function after coronary artery surgery: a prospective study. Anesth. Analg. 1992; 74: 8215.
  19. Madl C., Grimm G., Kramer L. et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet 1993; 341: 855–858.
  20. Newman M.F., Wolman R., Kanchuger M. et al. Multicenter preiperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Circulation 1996; 94 [suppl. II]: 74–80.
  21. Roach G.W., Kanchuger M., Mangano C.M. et al. Adverse cerebral outcomes after coronary bypass surgery. N. Engl. J. Med. 1996; 335: 1857–1863.
  22. Per Thorvaldsen M.D., Michael Davidsen. Stable stroke occurrence despite incidence reduction in an aging population. Stoke 1999; 30: 2529–2534.
  23. Sotaniemi. Long-term neurologic outcome after cardiac operation. Ann. Thome Surg. 1995; 59: 1336–39.
  24. Wolman R.L., Nussmeier N.A., Aggarwal A. et al. Cerebral injury after cardiac surgery: identification of a group at extraordinary risk. Multicenter Study of Perioperative Ischemia Research Group (McSPI) and the Ischemia Research Education Foundation (IREF) Investigators. Stroke 1999; 30: 514–522.
  25. WilliamsбRusso P., Sharrock N.E., Mattis S. et al. Cognitive effects after epidural vs. general аnesthesia in older adults: a randomized trial. JAMA. 1995; 274: 44–50.

Statistics

Views

Abstract: 1125

PDF (Russian): 747

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2009 Suslina Z.A., Bokeria L.A., Piradov M.A., Malashenkov A.I., Akhmadzhonuva N.A., Fedin P.A., Rodionova Y.V., Rebrova O.Y., Krotenkova M.V., Lagutin A.V., Klochkov A.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies