Background
Methods
Research participants
Randomization and masking
Procedure
Assessment of postoperative delirium
Neuropsychological assessment
Stroke evaluation
Statistical analysis
Results
Study population
Variable | IABP n = 34 | CG n = 33 | p-value |
---|---|---|---|
Gender, male | 27 (79.4%) | 24 (72.7%) | 0.520 |
Age, years | 64 ± 8 | 64 ± 10 | 0.750 |
LVEF (%) | 40 [36–42] | 40 [33–45] | 0.455 |
EuroSCORE | 6 [4–7] | 5 [3–6] | 0.158 |
Risk factors | |||
Previous cardiac surgery, n | 0 | 0 | – |
Previous myocardial infarction, n (%) | 31 (91.2%) | 24 (72.7%) | 0.049 |
Hypertension, n (%) | 26 (76.5%) | 27 (81.8%) | 0.427 |
Peripheral vascular disease, n (%) | 5 (14.7%) | 2 (6.1%) | 0.197 |
COPD, n (%) | 1 (2.9%) | 1 (3%) | 1.000 |
Current smoking, n (%) | 8 (23.5%) | 8 (24.2%) | 0.945 |
Previous smoking < 6 months, n (%) | 14 (41.2%) | 18 (54.5%) | 0.273 |
Dyslipidemia, n (%) | 19 (55.9%) | 27 (81.8%) | 0.022 |
Diabetes, n (%) | 16 (47.1%) | 17 (51.5%) | 0.715 |
Atrial fibrillation, n (%) | 3 (8.8%) | 2 (6.1%) | 1.000 |
Previous stroke, n (%) | 4 (11.8%) | 1 (3.0%) | 0.356 |
Hepatic disease, n (%) | 0 | 0 | – |
Obesity (BMI > 30) n (%) | 3 (8.8%) | 7 (21.2%) | 0.186 |
Left coronary trunk lesion > 50%, n (%) | 10 (29.4%) | 11 (33.3%) | 0.729 |
Valve disease, n (%) | 6 (17.6%) | 3 (9.1%) | 0.476 |
Medication | |||
Beta-blocker, n (%) | 25 (73.5%) | 29 (87.9%) | 0.138 |
ACE inhibitor, n (%) | 23 (67.6%) | 27 (81.8%) | 0.183 |
Acetylsalicylic acid, n (%) | 26 (76.5%) | 28 (84.8%) | 0.539 |
Vitamin K antagonist, n (%) | 1 (2.94%) | 2 (6.1%) | 0.614 |
Variable | IABP (n = 34) | Control (n = 33) | p value |
---|---|---|---|
Surgery type | |||
Isolated CABG | 32 | 32 | 1.000 |
No. of grafts | 0.110 | ||
1 | 0 | 1 | |
2 | 9 | 5 | |
3 | 10 | 19 | |
4 | 13 | 7 | |
5 | 2 | 1 | |
Duration of surgery, h | 5.1 [4.4–5.6] | 5.0 [4.3–6.0] | 0.594 |
Duration of CPB, min | 95 [75–113] | 92 [83–117] | 0.697 |
Aortic cross-clamp time, min | 75 [59–90] | 74 [58–90] | 0.874 |
RBC transfusion | 16 (47.1) | 8 (24.2) | 0.051 |
Antifibrinolytic | 32 (94.1) | 28 (87.5) | 0.420 |
Crystalloid, mL | 2000 ([500–2500] | 2500 [500–3250] | 0.094 |
Physiological and laboratory values
Peripheral hemodynamic parameters
Variable | IABP group (N = 34) | Control group (N = 33) | p-value effect IABP | p-value effect | ||||
---|---|---|---|---|---|---|---|---|
T1 | T2 | T3 | T1 | T2 | T3 | T1–T3 | ||
EtCO2 (mmHg) | 33.1 ± 3,6 | 33.1 ± 3.2 | 31.1 ± 3.4* | 34.7 ± 4.9 | 34.2 ± 4.0 | 33.0 ± 3.1* | 0.809 | 0.004 |
Mean BP (mmHg) | 91.1 ± 13.3 | 83.2 ± 13.4* | 89.0 ± 9.1 | 93.5 ± 13.6 | 80.4 ± 12.1* | 90.3 ± 8.3 | 0.853 | < 0.001 |
Systolic (BP mmHg) | 132.9 ± 20.3 | 127.0 ± 23.6* | 127.3 ± 18.3* | 138.1 ± 22.7 | 128.2 ± 17.2* | 125.8 ± 16.8* | 0.629 | 0.007 |
Diastolic BP (mmHg) | 67.9 ± 10.9 | 46.2 ± 13.9*# | 67.9 ± 8.7* | 69.4 ± 10.7 | 58.6 ± 11.7* | 70.7 ± 8.6* | 0.003 | < 0.001 |
HR (bpm) | 68.4 ± 11.4 | 103.8 ± 17.0* | 89.2 ± 15.9* | 61.9 ± 9.1 | 101.9 ± 13.0* | 90.5 ± 12.5* | 0.304 | < 0.001 |
ARI | 5.5 ± 1,9 | 4.0 ± 1.9* | 5.7 ± 2.0 | 5.7 ± 1.7 | 4.1 ± 1.6* | 5.7 ± 1.6 | 0.978 | < 0.001 |
ARI < 4 (n, %) | 7 (20.6%) | 18 (52.9%)* | 7 (20.5%) | 5 (15.1%) | 17 (51.5%)* | 4 (12.1%) | 0.138 | < 0.001 |
CBFV MCA (cm/s) | 57.3 ± 19.4 | 74.0 ± 21.6* | 71.1 ± 21.3* | 59.3 ± 11.8 | 74.7 ± 17.5* | 68.1 ± 15.1* | 0.952 | < 0.001 |
Systolic CBFV (cm/s) | 89.1 ± 28.5 | 107.6 ± 32.5* | 109.6 ± 30.2* | 90.6 ± 20.5 | 113.3 ± 24.7* | 101.1 ± 22.2* | 0.942 | < 0.001 |
Diastolic CBFV (cm/s) | 39.9 ± 11.4 | 33.2 ± 14.4*# | 49.0 ± 21.4 | 39.7 ± 8.2 | 51.5 ± 13.8 | 48.8 1 ± 0.8 | 0.001 | < 0.001 |
PI | 0.82 ± 0.15 | 1.03 ± 0.26*# | 0.85 ± 0.16 | 0.85 ± 0.17 | 0.84 ± 0.17 | 0.80 ± 0.18 | 0.001 | < 0.001 |
Cerebral autoregulation and cerebral hemodynamic parameters
Neurological complications
Variable | IABP group (N = 34) | Control group (N = 33) | p-value |
---|---|---|---|
Delirium (n, %) | 9 (26.5%) | 8 (24.2%) | 0.834 |
Seizure | 1 (2.9%) | 1 (3%) | 1.000 |
Stroke | 1 (3.0) | 1 (2.9%) | 1.000 |
Presurgery | |||
MoCA | 21 [18–24] | 21 [5–25] | 0.667 |
MoCA < 26 (n, %) | 30 (88.2%) | 28 (84.8%) | 1.000 |
MMSE | 25 [23–28.5] | 25 [23–28.5] | 0.632 |
MMSE ≤ 24 (n, %) | 13 (39.4%) | 14 (42.4%) | 1.000 |
Six months postsurgery (N = 24) | (N = 27) | ||
MoCA | 24.0 [20.2–25.0] | 20.0 [17–24.0] | 0.079 |
MoCA < 26 (n, %) | 19 (79.1%) | 22 (81.5%) | 1.000 |
MMSE | 28.0 [25.2–29.0] | 26 [23.0–29.0] | 0.216 |
MMSE ≤ 24 (n, %) | 4 (16.7%) | 11 (40.7%) | 0.073 |