Mufti Hani N, Alshaltoni Reham S, AlGahtani Adel, Jambi Farah, Milyani Ahmed, Zerpa Acosta Luis, Albugami Saad
Cardiac Surgery, King Faisal Cardiac Center, King Abdullah Medical City, Jeddah, SAU.
Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2020 Oct 28;12(10):e11211. doi: 10.7759/cureus.11211.
Background Neurocognitive complications (NCCs) after cardiac surgery are one of the most devastating complications. Significant internal carotid artery stenosis is assumed to be a predictor of NCCs. Carotid duplex ultrasound (DUS) is a non-invasive imaging study that remains the modality of choice and is routinely used in many centers for screening adult cardiac surgery patients prior to surgery. This study aims to assess the utility of preoperative carotid DUS in the prediction of NCCs in adult patients undergoing cardiac surgery in our center. Methods We retrospectively reviewed the medical records of patients who underwent coronary artery bypass graft (CABG), valvular or combined surgery, at King Faisal Cardiac Center in Jeddah between January 2017 and December 2018 (n = 229). The preoperative carotid DUS findings were evaluated. Risk factors associated with NCC were analyzed. Results Over the study period, a total of 229 patients underwent 233 procedures. Median age was 60 years (interquartile range [IQR] = 51-67 years), of whom 71% were males. Out of the diabetic patients, 67% had an HbA1C level above 7% pre-operatively. Carotid DUS was performed on 63% of patients, but only 6.9% developed a post-operative NCC. Patients who were actively smoking were more likely to develop NCC compared to nonsmokers or ex-smokers (14.7% vs 4.6%; p = 0.02), with an odds ratio of 3.6 (95% CI = 1.2-10.5). Patients who developed NCC had a significantly higher median intensive care length of stay (7 vs. 5 days; p = 0.05). Conclusions Although international guidelines clearly define which patient should get preoperative carotid DUS screening, the level of evidence is low. Based on our findings, preoperative routine use of carotid DUS prior to cardiac surgery has low utility in predicting NCC. We recommend a more tailored approach based on signs, symptoms, and high-risk features to optimize the utilization of resources, avoid unwarranted delays, and personalize patient care.
心脏手术后的神经认知并发症（NCCs）是最具破坏性的并发症之一。严重的颈内动脉狭窄被认为是NCCs的一个预测指标。颈动脉双功超声（DUS）是一种非侵入性成像检查，仍然是首选方式，并且在许多中心被常规用于术前筛查成年心脏手术患者。本研究旨在评估术前颈动脉DUS在预测我院成年心脏手术患者NCCs中的效用。方法：我们回顾性分析了2017年1月至2018年12月在吉达法赫德国王心脏中心接受冠状动脉旁路移植术（CABG）、瓣膜手术或联合手术的患者的病历（n = 229）。评估术前颈动脉DUS检查结果。分析与NCC相关的危险因素。结果：在研究期间，共有229例患者接受了233例手术。中位年龄为60岁（四分位间距[IQR]=51 - 67岁），其中71%为男性。在糖尿病患者中，67%术前糖化血红蛋白（HbA1C）水平高于7%。63%的患者接受了颈动脉DUS检查，但只有6.9%的患者术后出现NCC。与不吸烟者或已戒烟者相比，正在吸烟的患者更易发生NCC（14.7%对4.6%；p = 0.02）, 比值比为3.6（95%可信区间=1.2 - 10.5）。发生NCC的患者重症监护病房住院时间中位数显著更长（7天对5天；p = 0.05）。结论：尽管国际指南明确规定了哪些患者应接受术前颈动脉DUS筛查，但证据水平较低。基于我们的研究结果，心脏手术前常规使用颈动脉DUS在预测NCC方面效用较低。我们建议基于体征、症状和高危特征采用更具针对性的方法，以优化资源利用、避免不必要的延误并实现患者护理的个性化。
