Neuroprotection in cardiosurgery

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.