Morphological and Functional Changes in the Brain in the Long-Term Period after On-Pump Cabg

Purpose: evaluation of brain substance’s morphological state and dynamics of cerebral tissue perfusion in patients undergoing on-pump CABG surgery compared preoperative and late postoperative period.

Materials and methods. The study included 14 male patients who underwent on-pump CABG surgery. CT and PCT with intravenous bolus radiopaque drug in the cubital vein conducted to all patients in the preoperative period. Cranio-ventricular index, width III ventricle was measured. The presence and degree leukoaraiosis, the presence of cysts, areas of gliosis, CBF, CBV, TTP in symmetric cortical and subcortical regions was recorded. CT and PCT repeat after 5 years.

Results. In preoperative period III ventricle width was 6.8 ± 1.4 mm; cranio-ventricular index = 4.9 ± 1.3. It were found cysts on the level of the basal ganglia in two cases (14%). Leukoaraiosis detected in four patients (28%). PCT in the preoperative period noted the absence of blood flow asymmetry, reducing blood flow to the frontal lobes, in the area of the junction of the parietal, temporal and occipital lobes. Significant expansion of the III ventricle 8.5 ± 2.5 mm, reducing cranio-ventricular index 3.6 ± 0.5, increasing the number of cysts and glial changes in 6 (43%) cases,  leukoaraiosis in 8 (57%) cases, a significant increase in TTP in the index of the thalamus (11.5 ± 2.1 sec) was determined after the operation.

Conclusions. Сhronic cerebral ischemia revealed progression of  manifestations in the late postoperative period in patients  undergoing on-pump CABG. The identified changes are not a direct  result of on-pump CABG, because similar changes observed in  patients with atherosclerotic lesions of the microvasculature and  damage the blood-brain barrier and also in patients without cardiac surgery.

1. Bokeriya L.А., Rabotnikov V.S., Alshibaya M.D., Glyantsev S.P. Essay of history of coronary artery surgery. Moscow: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences, 2002. 244 p. (In Russian)

2. Yousif A., Addison D., Lakkis N., Rosengart T., Birnbaum Y., Virani S.S., Hamzeh I., Alam M. 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; 130: A19554.

3. Sharafeev A.Z., Postnikov A.V. Cardiocerebral Syndrome. The modern condition of the question. Vestnik sovremennoy klinicheskoy meditsiny. 2013; 6(1): 52–56. (In Russian)

4. Goto T., Maekawa K. Cerebral dysfunction after coronary artery bypass surgery. J. Аnesth. 2014; 28 (2): 242–248. DOI: 10.1007/s00540-013-1699-0.

5. Portnov Y.M., Semenov S.E., Kokov A.N. PCT in assessment of cerebral hemodynamics in coronary artery disease patients undergoing on-pump CABG. Sibirskiy meditsinskiy zhurnal. 2016; 31 (2): 34–37. (In Russian)

6. Edwards R.J., Dombrowski S.M., Luciano M.G., Pople I.K. Chronic hydrocephalus in adults. Brain Pathol. 2004; 14 (3): 325–336. DOI: 10.1111/j.1750-3639.2004.tb00072.x

7. Likosky D.S., Marrin C.A.S., Caplan L.R., Baribeau Y.R., Morton J.R., Weintraub R.M, Hartman G.S., Hernandez F., Braff S.P., Charlesworth D.C., Malenka D.J., Ross C.S., O’Connor G.T. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke. 2003; 34 (12): 2830–2834. DOI: https:/doi.org/10.1161/01.STR.0000098650.12386.B3.

8. Wardlaw J.M., Sandercock P.A.G., Dennis M.S., Starr J. Is breakdown of the blood- brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 2003; 34 (3): 806–812. DOI: 10.1161/01.STR.0000058480.77236.B3.

9. Barbarash L.S., Sumin A.N., Bezdenezhnykh A.V., Zhuchkova E.A., Barbarash O.L. Prevalence of polyvascular disease in patients with ischemic heart disease. Complex Issues of Cardiovascular Diseases. 2013; (3): 4–11. (In Russian) DOI: 10.17802/2306-1278-2013-3-4-11.

10. Markin S.P. The modern approach to diagnosis and treatment of chronic cerebral ischemia. Rossiyskiy Meditsinskiy Zhurnal. 2010; 8: 445–450. (In Russian)

11. Suslina Z.A. Cerebrovascular diseases: results and perspectives. Annaly Clinicheskoy i Experimentalnoy Nevrologii. 2007; 1: 10–16. (In Russian)