Are Standard Follow-Up Parameters Sufficient to Protect Neurocognitive Functions in Patients with Diabetes Mellitus who Underwent Coronary Artery Bypass Grafting?

Sacli, Hakan; Kara, Ibrahim

doi:10.21470/1678-9741-2019-0160

Hakan Sacli Correspondence Address: Hakan Saclihttps://orcid.org/0000-0001-7503-5716 Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Adnan Menderes Cad. Sağlık Sok. No: 195, Adapazarı, Sakarya, Turkey Zip code: 54040 E-mail: mdhakans@yahoo.com

MD

Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Sakarya, Turkey.

http://orcid.org/0000-0001-7503-5716

Ibrahim Kara

MD

Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Sakarya, Turkey.

Correspondence Address: Hakan Saclihttps://orcid.org/0000-0001-7503-5716 Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Adnan Menderes Cad. Sağlık Sok. No: 195, Adapazarı, Sakarya, Turkey Zip code: 54040 E-mail: mdhakans@yahoo.com

No conflict of interest.

Figures (1)
Tables (5)

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Fig. 1
Algorithm for the treatment of cerebral desaturation.

FiO₂=fraction of inspired oxygen; Hct=hematocrit; MAP=mean arterial pressure; PaCO₂=partial carbon dioxide; rSO₂=regional cerebral oxygenation

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Abbreviations, acronyms & symbols CABG = Coronary artery bypass grafting MoCA = Montreal Cognitive Assessment CPB = Cardiopulmonary bypass NIRS = Near-infrared spectroscopy DM = Diabetes mellitus O2Hb = Oxyhemoglobin EAU = Epiaortic ultrasound PCO2 = Partial carbon dioxide FiO2 = Fraction of inspired oxygen pO2 = Partial oxygen Hb = Hemoglobin POCD = Postoperative cognitive dysfunction HCT = Hematocrit rSO2 = Regional cerebral tissue oxygenation HHb = Deoxyhemoglobin SPSS = Statistical Package for the Social Sciences MAP = Mean arterial blood pressure TEE = Transesophageal echocardiography

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Table 1
Description of demographic characteristics.

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Table 2
Intraoperative and postoperative data.

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Table 3
Comparison of cognitive functions between and in the groups.

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Authors' roles & responsibilities HS Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published IK Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published

Abbreviations, acronyms & symbols
CABG	= Coronary artery bypass grafting	MoCA	= Montreal Cognitive Assessment
CPB	= Cardiopulmonary bypass	NIRS	= Near-infrared spectroscopy
DM	= Diabetes mellitus	O₂Hb	= Oxyhemoglobin
EAU	= Epiaortic ultrasound	PCO₂	= Partial carbon dioxide
FiO₂	= Fraction of inspired oxygen	pO₂	= Partial oxygen
Hb	= Hemoglobin	POCD	= Postoperative cognitive dysfunction
HCT	= Hematocrit	rSO₂	= Regional cerebral tissue oxygenation
HHb	= Deoxyhemoglobin	SPSS	= Statistical Package for the Social Sciences
MAP	= Mean arterial blood pressure	TEE	= Transesophageal echocardiography

	Group 1 (n=24)	Group 2 (n=26)	P-value
Age (years)	62±7.7	59.8±9.1	0.37
Sex, n (%)
Male	20 (83.3)	4 (16.7)	0.90
Female	22 (84.6)	4 (15.4)
Hypertension, n (%)	13 (54.2)	15 (57.7)	0.80
Hyperlipidemia, n (%)	11 (45.8)	9 (34.6)	0.42
Diabetes mellitus, n (%)	10 (41.7)	12 (46.2)	0.75
COPD, n (%)	6 (25)	0 (0)	0.01
CRF, n (%)	2 (8.3)	0 (0)	0.13
Smoking, n (%)	9 (37.5)	12 (46.2)	0.54
Ejection fraction, median (min-max)	55 (40-65)	55 (35-70)	0.61
PAD, n (%)	3 (12.5)	0 (0)	0.06
CVD, n (%)	1 (4.2)	0 (0)	0.29

	Group 1 (n=24)	Group 2 (n=26)	P-value
Number of grafts (mean±SD)	2.5±0.8	2.7±0.5	0.18
CPB time, median (min-max)	83 (40-217)	89 (35-153)	0.52
AC time, median (min-max)	45 (18-170)	50 (15-108)	0.65
Temperature (°C), median (min-max)	30 (28-34)	30 (28-33)	0.39
Major neurological deficit, n (%)	0 (0)	0 (0)	1.00
Mortality, n (%)	0 (0)	0 (0)	1.00
Reoperation for bleeding, n (%)	1 (4.2)	1 (3.8)	0.95
ICU length of stay (days), median (min-max)	3 (1-12)	2 (1-8)	0.04
Length of hospital stay median (min-max)	8 (6-28)	7 (5-16)	<0.01

Comparison of preoperative cognitive results between groups
	Group 1 (n=24)	Group 2 (n=26)	P-value
Mild cognitive decline, n (%)	5 (20.8)	6 (23.1)	1.00
Severe cognitive decline, n (%)	0 (0)	0 (0)	1.00
Mean MoCA score	24.8±2.2	25.2±2.0	0.59
Comparison of postoperative cognitive results between groups
	Group 1	Group 2	P-value
Mild cognitive decline, n (%)	13 (54.2)	5 (19.2)	0.02
Severe cognitive decline, n (%)	2 (8.3)	0 (0)	0.22
Mean MoCA score	23.6±2.6	26.0±2.3	0.001
Comparison of preoperative and postoperative cognitive results in the groups
	Preoperative	Postoperative	P-value
Group 1, Mean MoCA score	24.8±2.2	23.6±2.6	0.02
Group 2, Mean MoCA score	25.2±2.0	26.0±2.3	0.06

Authors' roles & responsibilities

HS

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published

IK

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published

[1] Correspondence Address: Hakan Saclihttps://orcid.org/0000-0001-7503-5716 Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Adnan Menderes Cad. Sağlık Sok. No: 195, Adapazarı, Sakarya, Turkey Zip code: 54040 E-mail: mdhakans@yahoo.com

Brasil

Brasil

Are Standard Follow-Up Parameters Sufficient to Protect Neurocognitive Functions in Patients with Diabetes Mellitus who Underwent Coronary Artery Bypass Grafting?

Abstract

Objective:

Methods:

Results:

Conclusion: