Clinical and anamnestic predictors of postoperative hypoxic and ischemic brain lesions and algorithms for their assessment of neurological support of сardiac surgery patients

Dmytro S.  Mankovskyi

Summary. Modern technologies of cardiac surgery (CS) can significantly affect the structure of mortality, disability and quality of life of patients with critical ischemic disease, valvular heart disease, cardiomyopathies. In recent years, the overall mortality after CS with the use of artificial circulation (AC) is characterized by a decrease of 20–25 %, while the frequency of hypoxic-ischemic lesions (HIL) of the brain is almost unchanged and, even in older age groups increases. The aim of the study – to develop an algorithm for assessing the risk of hypoxic-ischemic brain lesions as components of neurological support of cardiac surgery patients. Materials and Methods. The study was performed on the clinical basis of the State Institution "Heart Institute of the Ministry of Health of Ukraine" with the use of primary materials on cardiac surgery using artificial circulation; involved two groups of patients, formed by the method of copy-pair (by characteristics: age, sex, type of intervention): in the first (n = 340 people) – patients with brain HIL after interventions, in the second (n = 340 people) – without brain HIL. The study used the results of routine neurological, instrumental and laboratory examinations at the stages of surgical treatment with the completion of a special "Card of expert assessment of neurological support of a patient with cardiac surgery." Results. The comparative intergroup analysis revealed reliable (p <0.05) CAF, their ranking according to the general informativeness was performed and 10 most informative were included in the forecasting algorithm, sequence of the risk assessment procedure and compile the appropriate tabular algorithm, to which, in descending order of informativeness, the most prognostic value features and the corresponding prognostic coefficients are introduced. The forecasting technology is quite simple and to achieve one of the prognostic amounts, which allows you to perform a personalized risk assessment with the simultaneous distribution (correlation) of the surveyed persons to one of the three risk groups. Conclusions. The diagnostic value and prognostic value of clinical and anamnestic predictors of risk of hypoxic-ischemic brain lesions were studied, their prognostic profile was compiled, the algorithm of risk personification was developed and three main prognostic adverse syndromes were identified: psychoneurological (encephalopathy, arterial hypertension, closed craniocerebral injuries in the anamnesis), vascular dysfunction (violation of cerebral autoregulation, decreased left ventricular ejection fraction, history of stroke, asymmetry of blood supply), cardiovascular disorders (atrial fibrillation, "silent" carotid artery stenosis, the presence of atheroma of the ascending aorta

[1] Berisavac II, Jovanović DR, Padjen VV, Ercegovac MD, Stanarčević PD, Budimkić-Stefanović MS, Radović MM, et al. How to recognize and treat metabolic enceph-alopathy in neurology intensive care unit. Neurol India. 2017;65(1): 123-8.

[2] Dyogtyar VV, Changli NO. [Prevention of neurological complications in surgery of the thoraco-abdominal aorta]. Visnyk sertsevo-sudynnoi khirurhii. 2018;3: 68-70. Ukrainian.

[3] Demikhov O, Dehtyarova I, Demikhova N. Actual aspects of public health policy formation on the exam-ple of Ukraine. Bangladesh Journal of Medical Science. 2020;19(3): 358-64.

[4] Demikhov O, Dehtyarova I, Rud O, Khotyeev Y, Kuts L, Cherkashyna L, Demikhova N, et al. Arterial hyperten-sion prevention as an actual medical and social problem. Bangladesh Journal of Medical Science. 2020;19(4): 722-9.

[5] Demikhov O, Demikhova N, Zakharchenko M, Bu-meister L. Dynamic of endothelial dysfunction factors dur-ing treatment in renal hypertensive patients. Atherosclero-sis. 2019; 287.

[6] Demikhov O, Nei S, Demikhova N. Awareness study of patients with arterial hypertension. European Journal of Heart Failure. Oxford: edition European Society of Cardiology. 2019; 21(1): 570.

[7] Feigin VL. Anthology of stroke epidemiology in the 20th and 21st centuries: Assessing the past, the present, and envisioning the future. International Journal of Stroke. 2019;14(3): 223-37.

[8] Feigin VL, Roth GA, Naghavi M. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global burden of disease study 2013. Lancet Neurol. 2016;15: 913-24.

[9] Gopagondanahalli KR, Li J, Fahey MC, Hunt RW, Jenkin G, Miller SL, Malhotra A. Preterm hypoxic–ischemic encephalopathy. Front Pediatr. 2016;4: 114.

[10] Hahne K, Monning G, Samol A. Atrial fibrillation and silent stroke: links, risks, and challenges. Vascular Health Risk Management. 2016;12: 65-74.

[11] Gubler EV. [Clinical pathoinformatics in medicine and pediatrics]. Meditsina. 1992. Russian.

[12] O'Neal JB, Billings FT, Liu X, Shotwell MS, Liang Y, Shah AS, Ehrenfeld JM, et al. Risk factors for delirium after cardiac surgery: an historical cohort study outlining the influence of cardiopulmonary bypass. Can J Anaesth. 2017;64(11): 1129-37.

[13] Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association. Stroke. 2013;44(3): 870-947.

[14] Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: A global response is needed. World Health Organ. 2016;94: 634-4a.

[15] Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial fibrillation and mechanisms of stroke: Time for a new model. Stroke. 2016;47: 895-900.

[16] Costa MA, Gauer MF, Gomes RZ, Schafranski MD. Risk factors for perioperative ischemic stroke in cardiac surgery. Rev Bras Cir Cardiovasc. 2015;30(3): 365-72.

[17] Rebrova OY. [Statistical analysis of medical data. Application of the Statistica software package]. MedyaSfera. 2002; 312. Russian.

[18] Trufanov EA, Sviridova NK, Parnyakova TR. [Cerebrovascular diseases: morbidity, mortality, risk factors, diagnosis and treatmen]. Skhidno-yevropeiskyi nevrolohichnyi zhurnal. 2016;4(10): 17-20. Russian.

[19] Zerna C, Thomalla G, Campbell BCV, Rha JH, Hill MD. Current practice and future directions in the diagnosis and acute treatment of ischaemic. The Lancet. 2018;392(10154): 1247-56.

[20] Zozulya IS, Zozulya AL, Volosovets AO. [Some directions of improving the provision of medical care for stroke]. Ukrainskyi visnyk psykhonevrolohii. 2017;25(1): 84-5. Ukrainian.