Relation Between Cerebral Perfusion Changes and Mortality Scores During Cardiopulmonary Bypass at Adult Cardiac Surgery
Keywords: Adult cardiac surgery, cardiopulmonary bypass, cerebral NIRS
Introduction: This study aims to investigate the correlation between cerebral perfusion changes and mortality rate in individuals undergoing adult cardiac surgery. Patients and Methods: Between April 2018-August 2018, 91 adult individuals who underwent open heart surgery with cardiopulmonary bypass (CPB) were prospectively evaluated. Cerebral perfusion was monitored via near-infrared spectroscopy (NIRS). The NIRS values were recorded at four intervals: T0, just before CPB; T1, cooling period (time taken to reach targeted hypothermia); T2, warming period (time taken to reach normal body temperature); and T3, following minutes of termination of CPB. Euro Score II and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded for each individual. Results: The operations performed include coronary artery bypass surgery (n= 41, 45%), valvular surgery (n= 47, 51%), and coronary artery bypass combined with valvular surgery (n= 3, 4%). Median Euro Score II was calculated to be 1.1 (range 0.7-36.6), and median APACHE II score was calculated to be 6 (range 0-23). Mortality occurred in four individuals for whom the Euro Score II C index was 0.702 (confidence interval, 0.411- 0.993; p= 0.048) and APACHE-II score C index was 0.871 (confidence interval, 0.660-1; p= 0.010). During the operative period, cerebral NIRS values decreased during T3 period, and significant changes occurred at T0-T3 period, consequently leading to an increase in the APACHE-II scores and the prediction of mortality. Conclusion: The changes at NIRS values were related with higher mortality, morbidity, and predicting scores. It is now suggested that these changes can eventually be a good guide and predictor for the management of patients during preoperative and postoperative periods.