Batuhan ÖZAY, Zuhal AYKAÇ, Onur SOKULLU, Yeşim BİÇER, Şahin ŞENAY, Müge TAŞDEMİR, Serap Aykut AKA, Gökçen ORHAN

Kardiyopulmoner bypass ve atan kalpte koroner arter cerrahisi uygulanan hastalarda nörokognitif fonksiyonların karşılaştırılması

Amaç: Kardiyopulmoner bypass altında veya atan kalpte koroner arter bypass greftleme (KABG) yapılan hastalarda ameliyat sonrası erken dönemde nörokognitif fonksiyonlar değerlendirildi. Çalışma planı: Koroner arter bypass cerrahisi adayı 50 hasta, kardiyopulmoner bypass altında (n=25; ort. yaş 55±8) veya atan kalpte (n=25; ort. yaş 60±10) ameliyat edilmek üzere rastgele iki gruba ayrıldı. Nöropsikiyatrik değerlendirme ameliyattan bir gün önce ve ameliyat sonrası yedinci günde altı kognitif testle yapıldı. Kısa Mental Durum Testi ve nöropsikolojik testler kullanılarak dikkat, konsantrasyon, hafıza, görsel-uzaysal tanıma ve psikomotor performans değerlendirildi.Bulgular: Hasta gruplarının klinik ve demografik özellikleri, distal ve proksimal anastomoz sayıları benzer bulundu. Hiçbir grupta ölüm veya majör nörolojik komplikasyon görülmedi. İki grup arasında ameliyattan bir gün önce uygulanan nörokognitif testler açısından anlamlı fark yoktu. Ameliyat sonrası nörokognitif fonksiyonların her iki grupta da ameliyat öncesine göre anlamlı derecede bozulduğu görüldü. Kardiyopulmoner bypass altında ameliyat edilen grupta, Kısa Mental Durum Testi, frontal lob fonksiyonları, yüksek bilişsel fonksiyon testleri, geç dönem bellek testleri, görsel-konumsal yetenek testi puanlarındaki bozulma anlamlı derecede daha fazlaydı.Sonuç: Nörokognitif fonksiyonlar off-pump ve on-pump koroner cerrahi sonrasında baskılanmaktadır. Ancak, bulgularımız atan kalpte ameliyat edilen hastalarda nörokognitif fonksiyonların kısmen daha iyi korunduğunu göstermektedir.

Comparison of norocognitive functions in patients undergoing coronary bypass surgery under cardiopulmonary bypass or beating heart

Background: We evaluated early postoperative neurocognitive functions of patients undergoing coronary artery bypass grafting (CABG) performed under cardiopulmonary bypass or beating heart. Methods: Fifty patients undergoing elective CABG were randomized into two groups: conventional (n=25; mean age 55±8 years) or off-pump CABG (n=25; mean age 60±10 years). Neuropsychological assessments were performed one day before the operation and on the postoperative seventh day using six cognitive tests. Mini-Mental State Examination and neuropsychological test batteries were conducted to evaluate attention, concentration, memory, visual-spatial recognition, and psychomotor performance.Results: The two groups were similar with regard to clinical and demographic features and the number of distal and proximal anastomoses. No mortality or major neurological complications occurred. Preoperative neuropsychological assessments yielded similar scores in two groups. Postoperatively, both groups exhibited significant deterioration in neurocognitive tests. However, compared to patients in the off-pump CABG group, the scores of Mini-Mental State Examination, frontal lobe functions, cognitive tests, late memory tests, and visualspatial recognition were significantly lower in the conventional CABG group.Conclusion: Neurocognitive functions are depressed after both on-pump and off-pump coronary surgeries. However, our data suggest that neurocognitive functions are better preserved during off-pump CABG.

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