DYNAMICS OF COGNITIVE FUNCTIONS IN CHD PATIENTS OPERATED ON A"WORKING HEART" WITHOUT COMPRESSION OR WITH PARTIAL COMPRESSION OF THE AORTA

The aim of the research. Evaluation of the impact on cognitive functions (CF) of technologies for performing CABG surgery on the "beating heart" without clamping the aorta (Ao) or with partial clamping of the Ao.

Material and methods. According to the selection criteria, 57 patients were included in the study. All patients were operated on without artificial blood circulation on a "beating heart" access from a median sternotomy. A standard anesthetic manual was used. Patients are divided into three groups depending on the technique used. The first group included 25 patients who underwent partial clamping of Ao during the operation. The second group consisted of 22 patients in whom the HS system was used to create a proximal anastomosis, and the third group consisted of 10 patients who underwent mammary coronary artery bypass grafting. Evaluation of CF disorders was carried out before surgery and on the 7th day after surgery. The MMSE (Mini-mental State Examination) scale was used to assess violations.

Results. Before surgery, all patients had CF impairments, which were regarded as pre-dementia cognitive impairments. In patients of the first and third groups, there were no differences in the number of assessment points (p = 0.04 and p = 0.09). In patients of the second group, the difference between the initial data and 7 days after the operation is statistically significant (p = 0.004). In the first group, the number of points after surgery was 27.4 (26.5 - 29), in the second group - 28.5 (28 - 29) and in the third group - 25.9 (25 - 28). When compared between the groups, CF impairments after surgery did not have significant differences (p = 0.04).

Conclusion. Evaluation of CF in dynamics showed that when performing surgery on the "beating heart", regardless of the technology used for performing the proximal anastomosis with Ao, "controlled hypotension" with a decrease in SBP to 80 mm Hg does not cause cognitive dysfunction.

1. Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2018. 00. 1-96.

2. Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Journal of Cardio-thoracic Surgery. 2010. 38. S1-S52.

3. van Harten A.E., Scheeren T.W.L., Absalom A.R. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia. 2012. 66. 280-293.

4. Podkamenniy V.A., Zheltovskiy U.V., Gordeienok S.F., Likhandi D.I., Chepurnikh E.E., Borodashkina S.U., Medvedev A.V., Eroshevich A.V. The first experience of the system heartstring ii when performing coronary bypass on the «working heart» without clamping the aorta. Siberian Medical Journal. 2011. 1. 108-110. in Russian.

5. Tsoi K.K., Chan J.Y., Hirai H.W., Wong S.Y., Kwok T.C. Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis. JAMA Intern Med. 2015 Sep. 175(9). 1450-8.

6. Lee J.D., Lee S.J., Tsushima W.T., et al. Benefits of off-pump bypass on neurologic and clinical morbidity: A prospective randomized trial. Ann Thorac Surg. 2003. 76. 18-26.

7. Reston J.T., Tregear S.J., Turkelson C.M. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg. 2003. 76. 1510-1515.

8. Moritz S., Rochon J., Volkel S., et al. Determinants of cerebral oximetry in patients undergoing off-pump coronary artery bypass grafting: an observational study. European Journal of Anaesthesiology. 2010. 27. 542-54.

9. Emmerta M. Y., Grünenfeldera J., Schermana J., Cocchierib R., W-J. P. van Bovenb, Falka V., Salzbergb S. P. HEARTSTRING enabled no-touch proximal anastomosis for off-pump coronary artery bypass grafting: current evidence and technique. Interactive CardioVascular and Thoracic Surgery. 2013. 538–541.