Abstract
AimThis study was conducted to evaluate baseline INVOS values and identify factors influencing preoperative baseline INVOS values in carotid endarterectomy and cardiac surgery patients.MethodsThis is a prospective observational study on 157 patients (100 cardiac surgery patients, 57 carotid endarterectomy patients). Data were collected on factors potentially related to baseline INVOS values. Data were analyzed with student's t-test, Chi-square, Pearson's correlation or Linear Regression as appropriate.Results100 cardiac surgery patients and 57 carotid surgery patients enrolled. Compared to cardiac surgery, carotid endarterectomy patients were older (71.05 ± 8.69 vs. 65.72 ± 11.04, P < 0.001), with higher baseline INVOS (P < 0.007) and greater stroke frequency (P < 0.002). Diabetes and high cholesterol were more common in cardiac surgery patients. Right side INVOS values were strongly correlated with left-side values in carotid (r = 0.772, P < 0.0001) and cardiac surgery patients (r = 0.697, P < 0.0001). Diabetes and high cholesterol were associated with significantly (P < 0.001) lower INVOS and smoking was associated with higher INVOS values in carotid, but not in cardiac surgery patients. Age, sex, CVA history, Hypertension, CAD, Asthma, carotid stenosis side and surgery side were not related to INVOS. Multivariate analysis showed that diabetes is strongly associated with lower baseline INVOS values bilaterally (P < 0.001) and explained 36.4% of observed baseline INVOS variability in carotid (but not cardiac) surgery.ConclusionCompared to cardiac surgery, carotid endarterectomy patients are older, with higher baseline INVOS values and greater stroke frequency. Diabetes and high cholesterol are associated with lower baseline INVOS values in carotid surgery. Right and left side INVOS values are strongly correlated in both patient groups.
Highlights
Persistent cognitive decline or permanent neurologic deficits are common after cardiac or vascular surgery [1]
Published data suggest that significant intraoperative reduction of IN Vivo Optical Spectroscopy (INVOS) values correlates with adverse outcomes, and preliminary data suggest that prompt interventions in episodes of reduced INVOS values may contribute to improved outcomes
Cardiac surgery patients have higher frequency of high cholesterol and hypertension, whereas the two groups do not differ with regards to smoking and diabetes mellitus
Summary
Persistent cognitive decline or permanent neurologic deficits are common after cardiac or vascular surgery [1]. Other data show that more than 40% of patients undergoing cardiac surgery develop persistent cognitive decline resulting in functional impairment [4] and prolonged. The fraction of oxyhemoglobin can be determined by using two infrared wavelengths, thereby providing a technique for continuous non-invasive, bed-side monitoring that reflects the balance between cerebral oxygen supply and demand [5]. Other techniques, such as jugular venous saturation and electroencephalography have been used [6], but in this study we only evaluated INVOS
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