INCIDENCE OF NEUROLOGICAL COMPLICATIONS IN CORONARY ARTERY BYPASS GRAFTING VERSUS VALVE SURGERY (AORTIC, MITRAL, TRICUSPID); SINGLE CENTRE STUDY
Main Article Content
Keywords
cardiac surgery, valve surgery, neurological complications
Abstract
Introduction: Cardiac surgery continues to be a procedure with poor prognosis and compromised recovery, sometimes necessitating emergency department (ED) intervention for postoperative problems. Neurological complications mostly include neurocognitive dysfunction, stroke, seizures, delirium, and, in rare cases, coma.
Methodology: We observed 49 cases of cardiac surgery at our hospital over a period of six months and recorded the adverse neurological events. The data was analyzed on SPSS version 25
Results: There were 18 cardiopulmonary bypass surgery and 31 Valve Surgery cases among which, male female ratio was 11/7 and 17/14 respectively. There were three incidents of stroke and there was no significant relationship (p > 0.05).
Conclusion: Although the literature suggests that there is difference between cardiac surgery procedures in terms of neurological complications, but our study could not establish it due to small data.
References
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9. Gilbey T, Milne B, de Somer F, Kunst G. Neurologic complications after cardiopulmonary bypass - A narrative review. Perfusion. 2023 Nov;38(8):1545–59.
10. Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019 Aug;289:43–9.
11. Stessel B, Nijs K, Pelckmans C, Vandenbrande J, Ory J-P, Yilmaz A, et al. Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study. PLoS One. 2020;15(12):e0242519.
12. Hatfield SA, Nores MA, James TM, Rothenberg M, Kapila A, Cubeddu RJ, et al. Predictors and outcomes of stroke after transcatheter aortic valve replacement. J Card Surg. 2020 Jan;35(1):21–7.
13. Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, et al. Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc. 2019 Jul;8(13):e013032.
14. Laimoud M, Maghirang M, Alanazi M, Al-Mutlaq SM, Althibait SA, Alanazi B, et al. Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes. Egypt Hear J Off Bull Egypt Soc Cardiol. 2022 Oct;74(1):76.
15. Litvinenko I V, Odinak MM, Tsygan N V, Andreev R V, Peleshok AS, Kurasov ES, et al. [Characteristics of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve]. Zhurnal Nevrol i psikhiatrii Im SS Korsakova. 2019;119(2):18–22.
16. P. DA, J. RM, S. KN, J. PJ, M. VMN, G. GT, et al. Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients. J Am Coll Cardiol [Internet]. 2018 Oct 30;72(18):2109–19. Available from: https://doi.org/10.1016/j.jacc.2018.07.093
17. St Hilaire C, DeRieux J, Shenoda M, Casey K. Carotid Duplex Poorly Predicts Stroke Risk During Transcatheter Aortic Valve Replacement. Ann Vasc Surg. 2022 Aug;84:107–13.
18. Krishnan S, Sharma A, Subramani S, Arora L, Mohananey D, Villablanca P, et al. Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth. 2019 Nov;33(11):3182–95.
19. Llerena-Velastegui J, Navarrete-Cadena C, Delgado-Quijano F, Trujillo-Delgado M, Aguayo-Zambrano J, Villacis-Lopez C, et al. Frequency of Stroke in Intermediate-Risk Patients in the Long-Term Undergoing TAVR vs SAVR: A Systematic Review and Meta-Analysis. Curr Probl Cardiol. 2023 Sep;49(1 Pt B):102099.
20. El-Sabawi B, Cloud H, Patel JN, Bell SP, Elmariah S, Fearon WF, et al. Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv. 2023 Aug;16(8):e012875.
21. Masieh A, Freek N, Pierfrancesco A, H. E-VM, Rehana de V, A. DP, et al. Incidence, Predictive Factors, and Effect of Delirium After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv [Internet]. 2016 Jan 25;9(2):160–8. Available from: https://doi.org/10.1016/j.jcin.2015.09.037
22. Gorla R, Tua L, D’Errigo P, Barbanti M, Biancari F, Tarantini G, et al. Incidence and predictors of 30-day and 6-month stroke after TAVR: Insights from the multicenter OBSERVANT II study. Catheter Cardiovasc Interv [Internet]. 2023 Oct 4;n/a(n/a). Available from: https://doi.org/10.1002/ccd.30848
23. Ochani S, Adnan A, Siddiqui A, Kalwar A, Kukreja S, Ahmad M, et al. Postoperative delirium in 47 379 individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Ann Med Surg. 2023 Sep;85(9):4476–90.
24. Kroeze V, Olsthoorn J, Straten A, Princee A, Soliman Hamad M. Predictors and Outcomes of Stroke After Isolated Coronary Artery Bypass Grafting. A Single-Center Experience in 20,582 Patients. J Cardiothorac Vasc Anesth. 2023 Apr 1;37.
25. Leenders J, Overdevest E, van Straten B, Golab H. The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study. Perfusion. 2018 Nov;33(8):656–62.
26. Pakrad F, Pakrad E, Darvishi N, Poorolajal J. Preoperative Anxiety and Depression Increases the Incidence of Delirium After Coronary Artery Bypass Graft Surgery. J perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses. 2020 Oct;35(5):496–501.
27. Körber MI, Schäfer M, Vimalathasan R, Mauri V, Iliadis C, Metze C, et al. Prevalence and Impact of Post-Procedural Delirium After Percutaneous Repair of Mitral and Tricuspid Valves. JACC Cardiovasc Interv [Internet]. 2021;14(5):588–90. Available from: https://www.sciencedirect.com/science/article/pii/S1936879820323104
28. Tschernatsch M, El Shazly J, Butz M, Lie S-R, Yeniguen M, Braun T, et al. Visual Hallucinations following Coronary Artery Bypass Grafting: A Prospective Study. Medicina (Kaunas). 2022 Oct;58(10).
29. Cheng Z, Xu J, Guo Y. The Potential Causes of Paraplegia after Coronary Artery Bypass Grafting: A Literature Review. Heart Surg Forum. 2021 May;24(3):E487–92.
30. Woldendorp K, Indja B, Bannon PG, Fanning JP, Plunkett BT, Grieve SM. Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J. 2021 Mar;42(10):1004–15.
31. Tachibana H, Hiraoka A, Saito K, Naito Y, Chikazawa G, Tamura K, et al. Incidence and impact of silent brain lesions after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2021 Feb;161(2):636–44.
32. Indja B, Woldendorp K, Vallely MP, Grieve SM. Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019 May;8(9):e010920.
33. Aarts HM, Voskuil M. Cognitive function after transcatheter aortic valve implantation: the forgotten child. Netherlands Hear J [Internet]. 2023; Available from: https://doi.org/10.1007/s12471-023-01821-z
34. Yuan S-M, Lin H. Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting. Brazilian J Cardiovasc Surg. 2019;34(1):76–84.
35. Naito S, Demal TJ, Sill B, Reichenspurner H, Onorati F, Gatti G, et al. Neurological Complications in High-Risk Patients Undergoing Coronary Artery Bypass Surgery. Ann Thorac Surg. 2022 May;113(5):1514–20.
36. Dominici C, Salsano A, Nenna A, Spadaccio C, El-Dean Z, Bashir M, et al. Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease. J Card Surg [Internet]. 2019 Oct 1;34(10):941–7. Available from: https://doi.org/10.1111/jocs.14158
37. Szwed K, Słomka A, Pawliszak W, Szwed M, Anisimowicz L, Żekanowska E, et al. Novel Markers for Predicting Type 2 Neurologic Complications of Coronary Artery Bypass Grafting. Ann Thorac Surg. 2020 Aug;110(2):599–607.
38. Lorusso R, Moscarelli M, Di Franco A, Grazioli V, Nicolini F, Gherli T, et al. Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke. J Am Heart Assoc. 2019 Dec;8(24):e013650.
39. Gerçek M, Irimie AA, Gerçek M, Fox H, Fortmeier V, Rudolph TK, et al. Dynamics of Cognitive Function in Patients with Heart Failure Following Transcatheter Mitral Valve Repair. J Clin Med. 2022 Jul;11(14).
2. Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med. 2018 Dec;36(12):2289–97.
3. Alex S, Hiebert B, Arora R, Menkis A, Shah P. Survival and Long-Term Outcomes of Aortic Valve Replacement in Patients Aged 55 to 65 Years. Thorac Cardiovasc Surg. 2018 Jun;66(4):313–21.
4. Chaudhry MA, Sardar MR. Vascular complications of transcatheter aortic valve replacement: A concise literature review. World J Cardiol. 2017 Jul;9(7):574–82.
5. Grabert S, Lange R, Bleiziffer S. Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review. Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):469–76.
6. Barbero C, Marchetto G, Ricci D, Rinaldi M. Temporary Neurological Dysfunction After Minimal Invasive Mitral Valve Surgery: Influence of Type of Perfusion and Aortic Clamping Technique. Ann Thorac Surg. 2017 Feb 1;103:691–2.
7. Raffa GM, Agnello F, Occhipinti G, Miraglia R, Lo Re V, Marrone G, et al. Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome. J Cardiothorac Surg. 2019 Jan;14(1):23.
8. Pérez-Vela JL, Ramos-González A, López-Almodóvar LF, Renes-Carreño E, Escribá-Bárcena A, Rubio-Regidor M, et al. [Neurologic complications in the immediate postoperative period after cardiac surgery. Role of brain magnetic resonance imaging]. Rev Esp Cardiol. 2005 Sep;58(9):1014–21.
9. Gilbey T, Milne B, de Somer F, Kunst G. Neurologic complications after cardiopulmonary bypass - A narrative review. Perfusion. 2023 Nov;38(8):1545–59.
10. Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019 Aug;289:43–9.
11. Stessel B, Nijs K, Pelckmans C, Vandenbrande J, Ory J-P, Yilmaz A, et al. Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study. PLoS One. 2020;15(12):e0242519.
12. Hatfield SA, Nores MA, James TM, Rothenberg M, Kapila A, Cubeddu RJ, et al. Predictors and outcomes of stroke after transcatheter aortic valve replacement. J Card Surg. 2020 Jan;35(1):21–7.
13. Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, et al. Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc. 2019 Jul;8(13):e013032.
14. Laimoud M, Maghirang M, Alanazi M, Al-Mutlaq SM, Althibait SA, Alanazi B, et al. Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes. Egypt Hear J Off Bull Egypt Soc Cardiol. 2022 Oct;74(1):76.
15. Litvinenko I V, Odinak MM, Tsygan N V, Andreev R V, Peleshok AS, Kurasov ES, et al. [Characteristics of postoperative cerebral dysfunction depending on the type and position of the implanted prosthetic heart valve]. Zhurnal Nevrol i psikhiatrii Im SS Korsakova. 2019;119(2):18–22.
16. P. DA, J. RM, S. KN, J. PJ, M. VMN, G. GT, et al. Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients. J Am Coll Cardiol [Internet]. 2018 Oct 30;72(18):2109–19. Available from: https://doi.org/10.1016/j.jacc.2018.07.093
17. St Hilaire C, DeRieux J, Shenoda M, Casey K. Carotid Duplex Poorly Predicts Stroke Risk During Transcatheter Aortic Valve Replacement. Ann Vasc Surg. 2022 Aug;84:107–13.
18. Krishnan S, Sharma A, Subramani S, Arora L, Mohananey D, Villablanca P, et al. Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth. 2019 Nov;33(11):3182–95.
19. Llerena-Velastegui J, Navarrete-Cadena C, Delgado-Quijano F, Trujillo-Delgado M, Aguayo-Zambrano J, Villacis-Lopez C, et al. Frequency of Stroke in Intermediate-Risk Patients in the Long-Term Undergoing TAVR vs SAVR: A Systematic Review and Meta-Analysis. Curr Probl Cardiol. 2023 Sep;49(1 Pt B):102099.
20. El-Sabawi B, Cloud H, Patel JN, Bell SP, Elmariah S, Fearon WF, et al. Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv. 2023 Aug;16(8):e012875.
21. Masieh A, Freek N, Pierfrancesco A, H. E-VM, Rehana de V, A. DP, et al. Incidence, Predictive Factors, and Effect of Delirium After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv [Internet]. 2016 Jan 25;9(2):160–8. Available from: https://doi.org/10.1016/j.jcin.2015.09.037
22. Gorla R, Tua L, D’Errigo P, Barbanti M, Biancari F, Tarantini G, et al. Incidence and predictors of 30-day and 6-month stroke after TAVR: Insights from the multicenter OBSERVANT II study. Catheter Cardiovasc Interv [Internet]. 2023 Oct 4;n/a(n/a). Available from: https://doi.org/10.1002/ccd.30848
23. Ochani S, Adnan A, Siddiqui A, Kalwar A, Kukreja S, Ahmad M, et al. Postoperative delirium in 47 379 individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Ann Med Surg. 2023 Sep;85(9):4476–90.
24. Kroeze V, Olsthoorn J, Straten A, Princee A, Soliman Hamad M. Predictors and Outcomes of Stroke After Isolated Coronary Artery Bypass Grafting. A Single-Center Experience in 20,582 Patients. J Cardiothorac Vasc Anesth. 2023 Apr 1;37.
25. Leenders J, Overdevest E, van Straten B, Golab H. The influence of oxygen delivery during cardiopulmonary bypass on the incidence of delirium in CABG patients; a retrospective study. Perfusion. 2018 Nov;33(8):656–62.
26. Pakrad F, Pakrad E, Darvishi N, Poorolajal J. Preoperative Anxiety and Depression Increases the Incidence of Delirium After Coronary Artery Bypass Graft Surgery. J perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses. 2020 Oct;35(5):496–501.
27. Körber MI, Schäfer M, Vimalathasan R, Mauri V, Iliadis C, Metze C, et al. Prevalence and Impact of Post-Procedural Delirium After Percutaneous Repair of Mitral and Tricuspid Valves. JACC Cardiovasc Interv [Internet]. 2021;14(5):588–90. Available from: https://www.sciencedirect.com/science/article/pii/S1936879820323104
28. Tschernatsch M, El Shazly J, Butz M, Lie S-R, Yeniguen M, Braun T, et al. Visual Hallucinations following Coronary Artery Bypass Grafting: A Prospective Study. Medicina (Kaunas). 2022 Oct;58(10).
29. Cheng Z, Xu J, Guo Y. The Potential Causes of Paraplegia after Coronary Artery Bypass Grafting: A Literature Review. Heart Surg Forum. 2021 May;24(3):E487–92.
30. Woldendorp K, Indja B, Bannon PG, Fanning JP, Plunkett BT, Grieve SM. Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J. 2021 Mar;42(10):1004–15.
31. Tachibana H, Hiraoka A, Saito K, Naito Y, Chikazawa G, Tamura K, et al. Incidence and impact of silent brain lesions after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2021 Feb;161(2):636–44.
32. Indja B, Woldendorp K, Vallely MP, Grieve SM. Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019 May;8(9):e010920.
33. Aarts HM, Voskuil M. Cognitive function after transcatheter aortic valve implantation: the forgotten child. Netherlands Hear J [Internet]. 2023; Available from: https://doi.org/10.1007/s12471-023-01821-z
34. Yuan S-M, Lin H. Postoperative Cognitive Dysfunction after Coronary Artery Bypass Grafting. Brazilian J Cardiovasc Surg. 2019;34(1):76–84.
35. Naito S, Demal TJ, Sill B, Reichenspurner H, Onorati F, Gatti G, et al. Neurological Complications in High-Risk Patients Undergoing Coronary Artery Bypass Surgery. Ann Thorac Surg. 2022 May;113(5):1514–20.
36. Dominici C, Salsano A, Nenna A, Spadaccio C, El-Dean Z, Bashir M, et al. Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease. J Card Surg [Internet]. 2019 Oct 1;34(10):941–7. Available from: https://doi.org/10.1111/jocs.14158
37. Szwed K, Słomka A, Pawliszak W, Szwed M, Anisimowicz L, Żekanowska E, et al. Novel Markers for Predicting Type 2 Neurologic Complications of Coronary Artery Bypass Grafting. Ann Thorac Surg. 2020 Aug;110(2):599–607.
38. Lorusso R, Moscarelli M, Di Franco A, Grazioli V, Nicolini F, Gherli T, et al. Association Between Coronary Artery Bypass Surgical Techniques and Postoperative Stroke. J Am Heart Assoc. 2019 Dec;8(24):e013650.
39. Gerçek M, Irimie AA, Gerçek M, Fox H, Fortmeier V, Rudolph TK, et al. Dynamics of Cognitive Function in Patients with Heart Failure Following Transcatheter Mitral Valve Repair. J Clin Med. 2022 Jul;11(14).
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Nov 11, 2023
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Raja Umer Ejaz, Brig Nasir, & Amna Akbar. (2023). INCIDENCE OF NEUROLOGICAL COMPLICATIONS IN CORONARY ARTERY BYPASS GRAFTING VERSUS VALVE SURGERY (AORTIC, MITRAL, TRICUSPID); SINGLE CENTRE STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 2038–2047. https://doi.org/10.53555/jptcp.v30i18.3354
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Author Biographies
Raja Umer Ejaz
Resident Cardiac Surgery, AFIC/NIHD, Rawalpindi
Brig Nasir
Prof Cardiac Surgery, AFIC/NIHD, Rawalpindi, MBBS, FCPS Gen Surgery, FCPS Cardiac Surgery
Amna Akbar
Female Medical Officer, District Headquarter Hospital, Hattian Bala, AJK, Pakistan