Abstract
BackgroundIt is unknown whether cerebral oxygenation in patients with carotid artery stenosis (CAS) undergoing off-pump coronary artery bypass grafting (CABG) differs from that in patients without CAS. Thus, the effect of the presence of CAS ≥ 50 % on cerebral oxygenation during off-pump CABG in adult patients was evaluated retrospectively.MethodsEleven patients with CAS ≥ 50 % and 14 patients without CAS ≥ 50 % were enrolled. Regional cerebral tissue oxygen saturation (rSO2) was quantified using near-infrared spectroscopy. Mean arterial pressure, cardiac index, central venous pressure (CVP), and rSO2 at specific points were collected, and significant changes in each parameter were detected using repeated analysis of variance. Mean rSO2 and minimum rSO2 during anastomosis were analyzed by one-way analysis of variance. Multiple logistic regression analysis was used to estimate the odds ratio (OR) with 95 % confidence interval (CI) for cerebral desaturation (a decrease in rSO2 ≥ 10 % from preoperative value).ResultsTwo patients with CAS ≥ 50 % who received complete carotid artery stenting preoperatively were excluded from the analyses. In both patients with and without CAS, a decrease in rSO2 and cardiac index and an increase in CVP were observed during anastomosis. Mean (SD) maximum decrease in rSO2 from preoperative value was 9.2 (12.7) % on the left side and 8.1 (11.7) % on the right side in patients with CAS ≥ 50 %, and 13.5 (11.3) % on the left side and 16.1 (9.8) % on the right side in patients without CAS ≥ 50 % (p = 0.316). Neurological complications were not identified in both patients with and without CAS ≥ 50 %. In multiple logistic regression analysis, CAS ≥ 50 % was not associated with an increased risk of cerebral desaturation (OR 0.160, 95 % CI 0.036–0.707, p = 0.016), and rSO2 decreased with decreasing cardiac index < 2.0 l/min/m2 (OR 3.287, 95 % CI 2.218–5.076, p < 0.001).ConclusionsCAS ≥ 50 % was not an independent risk factor of cerebral desaturation during off-pump CABG. Our results suggest that maintaining cardiac output can prevent a decrease in cerebral oxygenation in both patients with and without CAS ≥ 50 %.
Highlights
It is unknown whether cerebral oxygenation in patients with carotid artery stenosis (CAS) undergoing off-pump coronary artery bypass grafting (CABG) differs from that in patients without CAS
In 3 of 9 patients with high-grade CAS, preoperative single photon emission computed tomography (SPECT) with acetazolamide stress was performed, but 6 other patients with high-grade CAS received CABG without preoperative SPECT with acetazolamide stress since the symptom of angina pectoris was uncontrollable by medical therapy
Since hemodynamic depression during cardiac displacement can lead to a decrease in cerebral oxygenation more frequently during off-pump CABG than on-pump CABG [21], patients with CAS, whose cerebral hemodynamic is impaired depending on the degree of stenosis [19], is likely to be associated with an increased risk of cerebral oxygen supply–demand mismatch to cause cerebral ischemia during off-pump CABG
Summary
It is unknown whether cerebral oxygenation in patients with carotid artery stenosis (CAS) undergoing off-pump coronary artery bypass grafting (CABG) differs from that in patients without CAS. Four to 17 % of patients undergoing CABG have carotid artery stenosis (CAS) ≥ 50 % [14, 15], and concomitant CAS is associated with an increased risk of stroke following on-pump CABG [16,17,18]. The pathophysiological mechanism of most postoperative ischemic strokes in patients with CAS undergoing on-pump CABG is thought to be microemboli from ascending aorta and/or carotid artery, or cardioembolism rather than hypoperfusion to cause cerebral oxygen supply–demand mismatch [17, 20]. CAS is likely to be associated with an increased risk of cerebral oxygen supply–demand mismatch to cause cerebral ischemia during off-pump CABG.
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