Murat BAŞTOPCU, Mehmet Erdem MEMETOĞLU, Abdülkerim ÖZHAN, Bülend KETENCİ, Sinan ŞAHİN, Canan KARAKAYA, Erhan GÜLER, Mahmut Murat DEMİRTAŞ

Göğüs grafisinde aort kalsifikasyonu ve koroner arter baypas greftleme sonrası nörokognitif bozulma arasındaki ilişkisi

Amaç: Bu çalışmada, koroner arter baypas greftleme yapılan hastalarda ameliyat öncesi göğüs grafisi ile tespit edilen aort kalsifikasyonu ile ameliyat sonrası nörokognitif bozulma arasındaki olası ilişki araştırıldı. Çalışma planı: Ocak 2019 - Temmuz 2019 tarihleri arasında kliniğimizde koroner arter baypas greftleme yapılan toplam 124 hasta (101 erkek, 23 kadın; ort. yaş: 59.9±8.8 yıl; dağılım, 34-84 yıl) çalışmaya alındı. Bu hastaların ameliyat öncesi çekilen göğüs grafisinde aort topuzu üzerinde aort kalsifikasyonu olan 35’i hasta grubunu oluşturdu. Aort kalsifikasyonu olmayan 89 hasta ise kontrol grubunu oluşturdu. Aort kalsifikasyonu saptanan hastalara ayrıca bilgisayarlı tomografi anjiyografi uygulandı ve çıkan aort ve arkus aorta kalsiyum skorları hesaplandı. Nörokognitif disfonksiyon, Standardize Mini Mental Test ile değerlendirildi. Ameliyat sonrası deliryum, yoğun bakım ünitesinde konfüzyon değerlendirme testi ile değerlendirildi. Gruplar demografik, ameliyat ve ameliyat sonrası verilere göre karşılaştırıldı. Bulgular: Çalışmaya alınan tüm hastalar arasında, genel serebrovasküler olay insidansı %3.2 idi. İstatistiksel olarak anlamlı olmamakla birlikte, nörokognitif gerileme olan hasta sayısı, kontrol grubuna kıyasla, hasta grubunda daha yüksek idi (sırasıyla %48.6 ve %34.8; p=0.157). Yüksek arkus aorta kalsiyum skorlu (>2250 AU) hastalarda Standardize Mini Mental Test skor düşüşü ve düşüş yüzdesi anlamlı olarak daha yüksek idi. Karotis arter darlığı, hasta grubunda 3.2 kat daha yüksekti. Karotis arter darlığı saptanan hastalarda, arkus aorta kalsiyum skoru da daha yüksek idi (p=0.042). Sonuç: Yüksek kalsiyum skorları ile birlikte göğüs grafisinde tespit edilen aort kalsifikasyonu, koroner arter baypas greftleme yapılan hastalarda nörokognitif bozulma ve karotis arter darlığı ile ilişkili olabilir.

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

Background: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. Methods: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. Results: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). Conclusion: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

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