ارتباط عوارض شناختي با يافته هاي داپلر عروق مغز و كاروتيد در بيماران باي پس كرونر انتخاب شده

Correlation ofcognitive complications with Doppler findings in selected coronary artery bypasses graft patients

Introduction: Nowadays coronary artery bypass graft (CABG) surgery is a common operation and postoperative complications are inevitable. Among the important complications are neurologic and cognitive ones. These problems have a significant role in the disability and the mortality of patients. The present study was designed to detect the frequency of postoperative cognitive complications, and the correlation of it with different risk factors such as age, sex, history of cerebrovascular disease, preoperative cerebrovascular hemodynamic state, intraoperative variables and neurologic complications. Methods & materials: In this descriptive, analytic, and prospective study, 201 elective patients, with normal sinus rhythm, ejection fraction of more than 30%, and isolated CABG, during a period of about one year were included. Neurologic examination, cognitive evaluation (by mini-mental state examination or MMSE), intracranial arteries study (by transcranial Doppler or TCD) and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up to discharge time. About one month later neurologic examination and MMSE were repeated. Results: Two hundred and one patients (158 male, 43 female) with the average age of 57.29±9.67 were studied. The history of cerebrovascular disease in 4.5% was detected. Out of them, 131 patients had three-coronary- vessel disease, 64 had twovessel- disease,5 one-vessel-disease, and 1 patient had diffuse coronary disease. TCD was performed in 183 patients and showed abnormal state in 23 and n irmal in 160 cases. The total number of involved arteries was 36, among which basilar artery was the most common (12 numbers). In 154 patients carotid duplex was performed, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in 1, and 75-90% stenosis in 2 cases. Abnormal intima media thickness (>0.7 mm) reported in 86 patients. Postoperative neurologic complication occurred as follows: 4 stroke, 7 deliriums, and 3 amnesia. One of the operated patients died . Postoperative MMSE can be performed in 154 patients, among them 45 showed decrement of MMSE (mean: 2.29). There were no significant correlations between MMSE decrement and age, sex, previous cerebrovascular disease, preoperative hemodynamic state. Difference of MMSE changes in CABG patients with neurologic complication (0.078) and the patients without complication (0.863) was noticeable, but was not statistically significant. Conclusion: This study shows that post operative cognitive complications in elective, normal sinus rhythm, ejection fraction of more than 30% and isolated CABG patients appears to be due to CNS structural lesions, but further study with larger sample is needed.