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• W2062034315 abstract "Introduction: Preoperative risk factors have been identified which predict central nervous system injury in coronary artery bypass grafting surgery (CABG). [1] The impact of alterable physiologic variables upon neurologic outcome is less well defined. The purpose of this study was to determine if minimum intraoperative hematocrit (HCT), maximum glucose concentration (GLC) or mean arterial pressure (MAP) influence neurologic outcome after CABG. Methods: Outcome data for 2,825 patients undergoing CABG at the Duke Heart Center were merged and analyzed with data from an intraoperative data acquisition system. Preoperative risk factors described by Newman, et al. [1] were used to calculate a predictive probability (Risk Index) of adverse neurologic outcome defined as stroke, persistent coma or transient ischemic attack. Preoperative hypertension (HTN) and carotid bruit (BRUIT) were also included as an independent predictor variables for analysis. A query of the database yielded values for HCT, GLC and MAP for each patient. MAPALT50, defined as the integrated area below a MAP of 50mmHg at each minute during cardiopulmonary bypass (CPB), provided an index of low MAP. MAPAGE50, defined as the area greater than or equal to a MAP of 50mmHg at each minute during CPB, provided an index of high MAP. Univariate logistic regression was performed on each of the predictor variables to determine association with mortality. Variables found significant (p<0.05) by univariate analysis were tested in a multivariable model controlling for Risk Index and CPB duration using backwards stepwise logistic regression. Results: Among the 2,825 patients studied, 1.3% suffered adverse neurologic outcome. Results of the univariate and multivariate analyses are displayed in Table 1. After controlling for Risk Index and CPB time, only MAPALT50 retained a significant association with outcome as shown in Figure 1, with greater MAPALT50 associated with improved neurologic outcome.Table 1: Predictors of Adverse Neurologic OutcomeFigure 1Discussion: We had expected to demonstrate that in patients at high risk for stroke, management of intraoperative variables played a role in neurologic outcome. However, there was no evidence that glucose level or minimum hematocrit were associated with outcome. The association between greater MAPALT50 (lower pressure) with less neurologic dysfunction persisted in all risk groups and may point to other mechanisms than hypoperfusion as the primary etiology of neurologic dysfunction associated with cardiac surgery." @default.
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• W2062034315 date "1999-04-01" @default.
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• W2062034315 title "ASSOCIATION OF MEAN ARTERIAL PRESSURE, MINIMUM HEMATOCRIT AND MAXIMUM GLUCOSE WITH NEUROLOGIC OUTCOME IN CARDIAC SURGERY" @default.
• W2062034315 doi "https://doi.org/10.1097/00000539-199904001-00086" @default.
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