Duynstee Friso, Keunen Ruud W M, van Sonderen Agnes, Keyhan-Falsafi Ali M, Hoohenkerk Gerard J F, Stephens Gayleen, Teeuws Erik, van Alphen Jan W K, Tavy Dénes L J, Mosch Arne, de Bruijn Sebastiaan F T M, van Overhagen Hans, Treurniet Frank E E, van Dijk Lucas C, van Kampen Paulien M
Department of Neurology and Clinical Neurophysiology, Haga Teaching Hospitals, The Hague, Netherlands.
Department of Cardiosurgery, Haga Teaching Hospitals, The Hague, Netherlands.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):765-771. doi: 10.1093/icvts/ivx171.
This study prospectively evaluates the impact of the Haga Braincare Strategy (HBS) on the occurrence of haemodynamic and embolic stroke in a cohort of patients who underwent coronay artery bypass grafting (CABG), valve replacement of a combination of both types of surgery between 2012 and 2015 at the Haga Teaching Hospitals.
The HBS is a dual strategy based on a preoperative vascular work-up of the cerebral circulation by transcranial Doppler and a perioperative monitoring of the cerebral circulation by cerebral oximetry. Duplex of the carotid arteries and/or computed tomography angiography prior to surgery was performed in high-risk patients. Patients with severe carotid artery stenosis were scheduled for carotid angioplasty prior to surgery or waived from surgery.
A total of 1065 patients were included. Poor cerebral haemodynamics were identified by transcranial Doppler in 2.1% of patients (n = 22). Based on the HBS, 3 patients were waived from surgery, 4 received preoperative carotid angioplasty followed by cardiac surgery and the remaining patients were operated while being monitored with bilateral cerebral oximetry sensors. In all, 2.2% of the study group experienced a stroke (n = 23), of which none were classified as haemodynamic. Most of the remaining presumed embolic strokes showed a minor to moderate stroke severity.
In this single-centre prospective follow-up study, surveillance of cerebral perfusion by the HBS eliminated the occurrence of haemodynamic stroke while most of the residual strokes had a good to favourable prognosis.
本研究前瞻性评估了哈加脑心策略（HBS）对2012年至2015年在哈加教学医院接受冠状动脉旁路移植术（CABG）、瓣膜置换术或两者联合手术的患者队列中血流动力学性和栓塞性卒中发生情况的影响。
HBS是一种双重策略，基于术前经颅多普勒对脑循环进行血管评估以及围手术期通过脑血氧饱和度监测脑循环。对高危患者在手术前进行颈动脉双功超声检查和/或计算机断层血管造影。严重颈动脉狭窄的患者在手术前安排进行颈动脉血管成形术或不进行手术。
共纳入1065例患者。经颅多普勒检查发现2.1%的患者（n = 22）存在脑血流动力学不良。根据HBS，3例患者未进行手术，4例接受了术前颈动脉血管成形术，随后进行心脏手术，其余患者在使用双侧脑血氧饱和度传感器监测的情况下接受手术。总体而言，研究组中有2.2%的患者发生了卒中（n = 23），其中无一例被归类为血流动力学性卒中。其余大多数推测为栓塞性卒中的严重程度为轻度至中度。
在这项单中心前瞻性随访研究中，HBS对脑灌注的监测消除了血流动力学性卒中的发生，而大多数残留卒中的预后良好至有利。
