OBJECTIVE
To analyze perioperative cognitive functions in patients undergoing isolated coronary artery bypass surgery (CABG) and CABG with simultaneous carotid endarterectomy (CEE).
MATERIAL AND METHODS
A comparative analysis of cognitive status enrolled 56 patients with multifocal atherosclerosis of coronary and precerebral arteries who underwent simultaneous CABG and CEE (mean age 64.8±7.1 years) and 67 patients with isolated coronary artery disease who underwent on-pump CABG (mean age 57.1±5.8 years). Neuropsychological study included Mini-Mental State Examination, Frontal Assessment Battery. Memory, attention and neurodynamics were assessed using the Status-PF system 2—3 days before and 5—7 days after surgery. Postoperative cognitive dysfunction was diagnosed in case of 20% decrease in memory, attention and neurodynamics from baseline values in 20% of tests. Statistical analysis was carried out using «Statistica 10.0» software package.
RESULTS
In preoperative period, 24 (36%) and 31 (55%) patients had moderate cognitive impairment, respectively (p=0.01). Patients with indications for combined surgery had better short-term memory. They reproduced more of ten memorized meaningless syllables compared to the isolated CABG group. Preoperative attention and neurodynamics were better in patients undergoing isolated CABG. So, they processed more characters at the fourth minute of the Bourdon test, had a higher speed in a complex visual-motor reaction test, functional mobility of nervous processes and brain working capacity. They also had a higher attention quotient. Analysis of cognitive status gradations revealed that most patients in both groups had low baseline cognitive status (38 (68%) and 30 (44.7%), respectively, p<0.0001). Low cognitive status was found in 11 (19.5%) and 23 (34.3%) patients, respectively, p<0.0001). Patients with middle cognitive status prevailed in the isolated CABG group (12 (18%) and 5 (9%), respectively, p<0.0001). The number of patients with intact cognitive status was similar in both groups.
CONCLUSION
Patients with multifocal atherosclerosis have a worse cognitive status compared to patients with isolated CAD before surgery and in early perioperative period, as well as higher risk of perioperative events. However, incidence of early postoperative cognitive dysfunction is similar in both groups. Both surgical interventions contribute to early postoperative cognitive dysfunction and have not confirmed their safety regarding prevention of secondary cerebrovascular complications.
