Delirium is a dangerous complication, prolonging intensive care unit stay and postoperative mortality. Factors associated with delirium development are advanced age, peripheral vascular disease, diminished cardiac function and blood product usage.

Background. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications. Materials and methods. A total of 127 consecutive adult patients undergoing on-pump coronary artery bypass grafting were studied. Neuropsychological testing was performed the day before surgery and 7–9 days after operation. Stepwise logistic regression analysis determined independent predictors of POCD. Results. The incidence of postoperative cognitive decline was 46% (n=59). Patients in the POCD group were older (P=0.04) and had an increased prevalence of asymptomatic carotid artery stenosis (P=0.0001). POCD was associated with longer time in surgery (P=0.018), inotropic support intraoperativelly (P=0.02) and during postoperative period (P=0.008). Patients in the POCD group had an increased incidence of postoperative bleeding (P=0.037), delirium (P=0.016) and stayed in hospital for a longer period (P=0.007). Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline. Conclusions. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline.

No abstract

Background. Women experience greater complications and early mortality after both percutaneous interventions and coronary bypass surgery (CABG). Coronary artery disease is becoming more prevalent among women. The aim of the study was to determine whether gender differences in outcomes of surgical treatment persist at our institution.Methods. A retrospective review of 3177 consecutive CABG patients operated on at our institution during a five-year period. A number of demographic and preoperative risk factors were analyzed to evaluate the risk of surgical procedure. Intraoperative variables reflected the surgical and anesthetic management of the patients. Mortality was the primary outcome, but major morbidity was also analyzed. Logistic regression analysis was performed to identify the independent predictors of postoperative mortality.Results. The observed crude mortality rate was higher in women than in men (5.2% vs 2.8%, p < 0.05). Women were older (67.5 ± 8.3 vs 63.1 ± 9.4 years, p < 0.001) and had a greater incidence of comorbidities. The internal thoracic artery as a conduit was used with a lower rate in female patients (62.5% vs 77.8%, p < 0.01). Women had a higher rate of low cardiac output syndrome, were less likely to be extubated early following the procedure and required a higher rate of blood transfusions (45.2% vs 25.4%, p < 0.01). Logistic regression analysis revealed that age, left ventricle ejection fraction and female gender were significant independent predictors of postoperative mortality.Conclusion. Despite advances in surgical and anesthetic techniques, female patients are operated on with an almost twice as high mortality rate as men. The risk profile of female patients differs greatly from male patients. These factors could have a negative impact on the results of surgical treatment of women.

No abstract

Background. The aim of the study was to compare the accuracy of general scoring systems on ICU arrival with preoperative evaluation using the EuroSCORE risk model in patients undergoing cardiac surgery.Methods. Ethical committee approved a prospective observational study. Data for 514 consecutive CABG patients operated during one year period were collected. EuroSCORE risk score before surgery and APA-CHE II, SAPS II and MODS on ICU admission following surgery were calculated for all patients. Calibration of the risk stratification models was performed using the Hosmer-Lemeshow Goodness-of-Fit test, discrimination was made using Receiver Operative Characterictic (ROC) Curves. Predicted values of the risk scoring systems were compared with the actual mortality rate.Results. The observed crude hospital mortality rate of patients during the study period was 2.7%. All risk scoring systems overestimated mortality (Apache II -12.2%, SAPS II -5.5%, MODS -6.8%, Euro-SCORE -4.5%). Hovewer, the preoperative EuroSCORE Risk Stratification System performed better than the postoperative General Severity scoring systems on ICU admission, while the APACHE II system showed the worst discriminatory capability.Conclusions. General Severity scoring systems on ICU arrival following cardiac surgery have worse discriminatory ability in predicting hospital mortality compared to the EuroSCORE Risk Evaluation System performed preoperatively.

Įvadas / tikslasProfilaktinis milrinono skyrimas gerina širdies veiklą, sumažina pooperacinės intraaortinės balioninės kontrapulsacijos (IABK) poreikį. Keletas atliktų tyrimų patvirtino priešoperacinės IABK naudą išgyvenamumui. Pagrindinis mūsų tyrimo tikslas buvo palyginti IABK arba milrinono skyrimo didelės rizikos pacientams, kuriems atliekamos miokardo revaskuliarizacijos operacijos, įtaką hemodinamikos rodikliams ir pooperaciniam sergamumui.Ligoniai ir metodaiTai retrospektyvioji 29-ių didelės rizikos pacientų, kuriems atliktos miokardo revaskuliarizacijos operacijos per vienerius metus tame pačiame centre, duomenų analizė. Pacientai, kurie operuoti be dirbtinės kraujo apytakos, į tyrimą neįtraukti. Milrinonu gydyta 14 pacientų, intraaortine balionine kontrapulsacija – 15 pacientų. Abiejų grupių pacientų hemodinamika stebėta įkišus Swan-Ganz kateterį. Buvo vertinami priešoperaciniai rizikos veiksniai, operaciniai duomenys, pooperacinis sergamumas ir hemodinamikos rodikliai.RezultataiPalyginus grupes prieš operaciją, jos statistiškai patikimai nesiskyrė pagal amžių (64 ± 10 vs 66 ± 9), lyčių pasiskirstymą (vyrai/moterys, 12/3 vs 11/3) ar operacinę riziką, vertinamą Euroscore balais (5,5 ± 3,8 vs 4,9 ± 2, p=0,69). Kairiojo skilvelio išvaromoji frakcija buvo mažesnė pacientų, gydytų taikant intraaortinę kontrapulsaciją (35 ± 5 proc. vs 39 ± 5 proc., p=0,03). Palygintas operacinis ir pooperacinis minutinis širdies tūris. Milrinonu gydytiems pacientams reikėjo didesnių dozių norepinefrino pirmosiomis pooperacinėmis valandomis (0 val. 0,07 ± 0,06 vs 0,01 ± 0,02 μg/kg/min., p=0,01, ir po 4 val. 0,08 ± 0,05 vs 0,03 ± 0,02 μg/kg/min., p=0,01). Pooperacinės komplikacijos tarp grupių statistiškai patikimai nesiskyrė: širdies nepakankamumas (29 proc. vs 33 proc.), insultas (7 proc. vs 7 proc.), inkstų funkcijos sutrikimas (7 proc. vs 13 proc.), delyras (22 proc. vs 13 proc.). Gydymo trukmė Reanimacijos ir intensyviosios terapijos skyriuje buvo panaši (6 ± 7 vs 4 ± 2 dienos). Keturiems (29 proc.) milrinono grupės pacientams prireikė IABK širdies nepakankamumui gydyti pooperaciniu laikotarpiu.IšvadosProfilaktinė IABK dažniau skirta pacientams, kurių kairiojo skilvelio išvaromoji frakcija mažesnė. Priešoperacinis milrinono ar IABK skyrimas turėjo panašią įtaką pacientų širdies veiklos gerinimui. Abiejų grupių ligonių pooperacinis sergamumas nesiskyrė. Tačiau 29 proc. milrinonu gydytų pacientų prireikė intraaortinės kontrapulsacijos pooperaciniu laikotarpiu.Reikšminiai žodžiai: miokardo revaskuliarizavimas, intraaortinė balioninė kontrapulsacija, milrinonas Preemptive milrinone versus intraaortic balloon pump in high risk coronary artery bypass grafting surgeryBackground / objectivePre-emptive milrinone infusion improves cardiac performance. The decrease of postoperative IABP insertions was possibly related with the increased use of phosphodiesterase inhibitors. The survival benefit of preoperative treatment with IABP was shown in several studies. The aim of our study was to compare the impact of the prophylactic administration of milrinone or IABP on haemodynamics and postoperative morbidity in high-risk patients undergoing on-pump CABG surgery.Patients and methodsThe retrospective analysis involved 29 elective high-risk CABG patients operated on during one year period in a single institution. Patients operated off-pump were excluded from the study. Pretreatment with milrinone was performed in 14 patients while prophylactic IABP was used in 15 cases. A Swan–Ganz catheter was inserted for haemodynamic monitoring in all cases. Preoperative risk factors, intraoperative variables, postoperative morbidity and haemodynamics were compared between the groups.ResultsPreoperative patient profile was comparable between the groups. There were no difference in patient age (64 ± 10 vs 66 ± 9), male / female ratio (12/3 vs 11/3) or preoperative Euroscore (5.5 ± 3.8 vs 4.9 ± 2, p = 0.69). However, the left ventricle ejection fraction was lower in the IABP-treated patient group (35 ± 5 perc. vs 39 ± 5 perc., p = 0.03). Inrtaoperative and postoperative cardiac output was comparable between the groups. Milrinone-treated patients had higher requirement of norepinephrine on ICU arrival (0.07 ± 0.06 vs 0.01 ± 0.02 μg/kg/min, p = 0.01) and 4 hours following surgery (0.08 ± 0.05 vs 0.03 ± 0.02 μg/kg/min, p = 0.01). No differences were found in the rate of heart failure (29 perc. vs 33 perc.), stroke (7 perc. vs 7 perc.), renal failure (7 perc. vs 13 perc.), postoperative delyrium (22 perc. vs 13 perc.) or ICU stay duration ( 6 ± 7 vs 4 ± 2 days). Four of 14 (29 perc.) patients needed IABP insertion in the postoperative period due to heart failure progression.ConclusionsProphylactic treatment with IABP was used in patients with a lower left ventricle ejection fraction. Pre-emptive milrinone infusion and IABP insertion before surgery had a similar impact on the improvement of cardiac performance during on-pump CABG surgery. No difference in postoperative morbidity was found between the groups of patients. However, almost 29 perc. of patients treated with milrinone needed IABP insertion in the postoperative period.Key words: coronary revascularization, intraaortic balloon counterpulsation, milrinone

Įvadas / tikslasProfilaktinis milrinono skyrimas gerina širdies veiklą, sumažina pooperacinės intraaortinės balioninės kontrapulsacijos (IABK) poreikį. Keletas atliktų tyrimų patvirtino priešoperacinės IABK naudą išgyvenamumui. Pagrindinis mūsų tyrimo tikslas buvo palyginti IABK arba milrinono skyrimo didelės rizikos pacientams, kuriems atliekamos miokardo revaskuliarizacijos operacijos, įtaką hemodinamikos rodikliams ir pooperaciniam sergamumui.Ligoniai ir metodaiTai retrospektyvioji 29-ių didelės rizikos pacientų, kuriems atliktos miokardo revaskuliarizacijos operacijos per vienerius metus tame pačiame centre, duomenų analizė. Pacientai, kurie operuoti be dirbtinės kraujo apytakos, į tyrimą neįtraukti. Milrinonu gydyta 14 pacientų, intraaortine balionine kontrapulsacija – 15 pacientų. Abiejų grupių pacientų hemodinamika stebėta įkišus Swan-Ganz kateterį. Buvo vertinami priešoperaciniai rizikos veiksniai, operaciniai duomenys, pooperacinis sergamumas ir hemodinamikos rodikliai.RezultataiPalyginus grupes prieš operaciją, jos statistiškai patikimai nesiskyrė pagal amžių (64 ± 10 vs 66 ± 9), lyčių pasiskirstymą (vyrai/moterys, 12/3 vs 11/3) ar operacinę riziką, vertinamą Euroscore balais (5,5 ± 3,8 vs 4,9 ± 2, p=0,69). Kairiojo skilvelio išvaromoji frakcija buvo mažesnė pacientų, gydytų taikant intraaortinę kontrapulsaciją (35 ± 5 proc. vs 39 ± 5 proc., p=0,03). Palygintas operacinis ir pooperacinis minutinis širdies tūris. Milrinonu gydytiems pacientams reikėjo didesnių dozių norepinefrino pirmosiomis pooperacinėmis valandomis (0 val. 0,07 ± 0,06 vs 0,01 ± 0,02 μg/kg/min., p=0,01, ir po 4 val. 0,08 ± 0,05 vs 0,03 ± 0,02 μg/kg/min., p=0,01). Pooperacinės komplikacijos tarp grupių statistiškai patikimai nesiskyrė: širdies nepakankamumas (29 proc. vs 33 proc.), insultas (7 proc. vs 7 proc.), inkstų funkcijos sutrikimas (7 proc. vs 13 proc.), delyras (22 proc. vs 13 proc.). Gydymo trukmė Reanimacijos ir intensyviosios terapijos skyriuje buvo panaši (6 ± 7 vs 4 ± 2 dienos). Keturiems (29 proc.) milrinono grupės pacientams prireikė IABK širdies nepakankamumui gydyti pooperaciniu laikotarpiu.IšvadosProfilaktinė IABK dažniau skirta pacientams, kurių kairiojo skilvelio išvaromoji frakcija mažesnė. Priešoperacinis milrinono ar IABK skyrimas turėjo panašią įtaką pacientų širdies veiklos gerinimui. Abiejų grupių ligonių pooperacinis sergamumas nesiskyrė. Tačiau 29 proc. milrinonu gydytų pacientų prireikė intraaortinės kontrapulsacijos pooperaciniu laikotarpiu.Reikšminiai žodžiai: miokardo revaskuliarizavimas, intraaortinė balioninė kontrapulsacija, milrinonas Preemptive milrinone versus intraaortic balloon pump in high risk coronary artery bypass grafting surgeryBackground / objectivePre-emptive milrinone infusion improves cardiac performance. The decrease of postoperative IABP insertions was possibly related with the increased use of phosphodiesterase inhibitors. The survival benefit of preoperative treatment with IABP was shown in several studies. The aim of our study was to compare the impact of the prophylactic administration of milrinone or IABP on haemodynamics and postoperative morbidity in high-risk patients undergoing on-pump CABG surgery.Patients and methodsThe retrospective analysis involved 29 elective high-risk CABG patients operated on during one year period in a single institution. Patients operated off-pump were excluded from the study. Pretreatment with milrinone was performed in 14 patients while prophylactic IABP was used in 15 cases. A Swan–Ganz catheter was inserted for haemodynamic monitoring in all cases. Preoperative risk factors, intraoperative variables, postoperative morbidity and haemodynamics were compared between the groups.ResultsPreoperative patient profile was comparable between the groups. There were no difference in patient age (64 ± 10 vs 66 ± 9), male / female ratio (12/3 vs 11/3) or preoperative Euroscore (5.5 ± 3.8 vs 4.9 ± 2, p = 0.69). However, the left ventricle ejection fraction was lower in the IABP-treated patient group (35 ± 5 perc. vs 39 ± 5 perc., p = 0.03). Inrtaoperative and postoperative cardiac output was comparable between the groups. Milrinone-treated patients had higher requirement of norepinephrine on ICU arrival (0.07 ± 0.06 vs 0.01 ± 0.02 μg/kg/min, p = 0.01) and 4 hours following surgery (0.08 ± 0.05 vs 0.03 ± 0.02 μg/kg/min, p = 0.01). No differences were found in the rate of heart failure (29 perc. vs 33 perc.), stroke (7 perc. vs 7 perc.), renal failure (7 perc. vs 13 perc.), postoperative delyrium (22 perc. vs 13 perc.) or ICU stay duration ( 6 ± 7 vs 4 ± 2 days). Four of 14 (29 perc.) patients needed IABP insertion in the postoperative period due to heart failure progression.ConclusionsProphylactic treatment with IABP was used in patients with a lower left ventricle ejection fraction. Pre-emptive milrinone infusion and IABP insertion before surgery had a similar impact on the improvement of cardiac performance during on-pump CABG surgery. No difference in postoperative morbidity was found between the groups of patients. However, almost 29 perc. of patients treated with milrinone needed IABP insertion in the postoperative period.Key words: coronary revascularization, intraaortic balloon counterpulsation, milrinone