PCT IN ASSESSMENT OF CEREBRAL HEMODYNAMICS IN CORONARY ARTERY DISEASE PATIENTS UNDERGOING ONXPUMP CABG

Coronary bypass surgery is the most effective and radical method for treatment of coronary heart disease, and most often performed under cardiopulmonary bypass that leads to numerous neurological complications postoperatively. Objective: to improve the diagnosis of changes in cerebral tissue perfusion by perfusion computed tomography (PCT) in patients with coronary heart disease and hypertension undergoing on-pump CABG. Materials and Methods. The study included 164 male patients, divided into 3 groups depending on the presence and duration of hypertension. PCT was performed before and after on-pump CABG. Results. Differences in perfusion rates of cerebral blood flow, both before and after the operation, depended on the presence and duration of hypertension. The most well preserved cerebral blood flow was determined in patients without history of concomitant hypertension. CBF indicators in zones A (43.8±4.6 mL/100 g * min) and M3 (49.4±5.6 mL/min * 100g) in patients with essential hypertension were below the threshold value of 50 mL/ 100 g * min. Postoperatively, CBF values increased in left M2, right M2, right M3, left L, and right L; CBV values increased in left M2 and right M2 only in patients with a long history of hypertension. 

1. Бокерия Л.А. и др. Микроэмболизация церебрального кровотока при операциях с искусственным кровообращением: интраоперационные, гемореологические и эхокардиографические корреляты // Анн. хир. – 2009. – №. 6. – С. 79–87.

2. Бокерия Л.А., Голухова Е.З., Полунина А.Г. и др. Церебральный кровоток при операциях с искусственным кровообращением // Креативная кардиология. – 2010. – № 1. – С. 97– 108.

3. Дементьева И.И., Морозов Ю.А., Федулова С.В. и др. Роль агрегации эритроцитов в формировании микроэмболов в сосудах головного мозга при операциях на аорте // Кардиология и сердеч.-сосуд. хир. – 2009. – № 2. – С. 66–69.

4. Ефимова Н.Ю., Ефимова И.Ю., Чернов В.И. и др. Когнитивные функции и перфузия головного мозга у больных ишемической болезнью сердца после операции аортокоронарного шунтирования // Грудная и сердечно(сосудистая хирургия. – 2002. – № 6. – С. 46–50.

5. Семенов С.Е., Молдавская И.В., Семенов А.С. и др. Критерии МР- и КТ-дифференциальной диагностики венозного и артериального инсульта // Мед. визуализация. – 2010. – № 6. – С. 41–49.

6. Kalra L. Cognitive function and hypertension // J. Human Hypertension. – 2009. – Vol. 23(2). – P. 86–96.

7. Ono M. et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality // J. Thorac. Cardiovasc. Surgery. – 2014. – Vol. 147, No. 1. – P. 483–489.

8. Reineke D. et al. Minimized extracorporeal circulation does not impair cognitive brain function after coronary artery bypass grafting // Interactive Cardiovasc. Thoracic surgery. – 2014. – Vol. 20, Issue 1. – P. 68–73.

9. Restrepo L. et al. Diffusion(and perfusion(weighted magnetic resonance imaging of the brain before and after coronary artery bypass grafting surgery // Stroke. – 2002. – Vol. 33, No. 12. – P. 2909–2915.

10. Yousif A. et al. Is Coronary Artery Bypass Grafting (CABG) with Cardiopulmonary Bypass Support (On(pump) Superior to CABG Without Bypass Support (Off(pump) in the High(Risk?: A Meta( Analysis of Randomized Controlled Trials (RCTs) // Circulation. – 2014. – Vol. 130. –Suppl. 2. – P. A19554–A19554.