Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Perioperative risk factors for stroke in patients after left ventricular geometric reconstruction

Authors: Lobacheva G.V., Alshibaya M.D., Mamalyga M.L., Maksimova A.G.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2024-21-1-18-35

UDC: 616.831-005+616.124.2]-089-06

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (1): 18-35

Quote as: Lobacheva G.V., Alshibaya M.D., Mamalyga M.L., Maksimova A.G. Perioperative risk factors for stroke in patients after left ventricular geometric reconstruction. Clinical Physiology of Circulation. 2024; 21 (1): 18–35 (in Russ.). DOI: 10.24022/1814-6910-2024-21-1-18-35

Received / Accepted:  17.01.2024 / 15.02.2024

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Abstract

Objective. Identification of the main prognostic risk factors for acute cerebral disorders and their threshold values in the early postoperative period after left ventricular geometric reconstruction (LVGR).

Material and methods. A retrospective case-control study included 52 patients who underwent LVGR. Group 1 – patients with uncomplicated postoperative period, Group 2 – patients with early postoperative stroke. Data were collected before the operation, on admission to the ICU, and on the 3rd day of the postoperative period.

Results. Cardiac output in the early postoperative period decreases by 26% and 14% in patients of groups 1 and 2, respectively (p < 0.05). Decreased cardiac output against the background of decreased oxygen capacity of blood leads to decreased oxygen delivery by 36.6% in group 1 and 33.8% in group 2 (p < 0.05). The following disorders of colloid- osmotic and water-electrolyte status in ICU were found to increase the risk of stroke in the early postoperative period: hypernatremia (OR = 1.46, p = 0.017), hyperlactatemia (OR = 1.46, p = 0.023), hyperglycemia (OR = 1.35, p=0.032), plasma hyperosmolarity (OR = 1.16, p = 0.009), hypoalbuminemia (OR = 0.75, p = 0.045). In this connection according to the results of one-factor analysis a 1 mmol/L increase in sodium at levels greater than 148.5 mmol/L increases stroke risk 19.8-fold (p = 0.012); a 1 mmol/L increase in glucose at levels greater than 18 mmol/L increases stroke risk 7-fold (p = 0.031); increase in lactate by 1 mmol/L at levels greater than 11.8 mmol/L – 12-fold (p = 0.031); increase in osmolarity by 1 mosmol/kg at levels greater than 310 mosmol/kg – 63-fold (p = 0.001); decrease in albumin by 1 g/L at levels less than 30.5 g/L – 10.5-fold (p = 0.018).

Conclusion. The parameters of water-electrolyte and colloid-oncotic state parameters that can be used as a threshold value for predicting the risk of stroke in clinical decision making in patients were determined. Thus, the threshold maximum value of sodium was 148.5 mmol/L, glucose – 18.1 mmol/L, plasma osmolarity – 310 mosm/kg.

About Authors

  • Galina V. Lobacheva, Dr. Med. Sci., Professor, Head of the Department of Reanimation and Intensive Care; ORCID
  • Mikhail M. Alshibaya, Dr. Med. Sci., Professor, Head of the Department of Surgical Treatment of Coronary Heart Disease; ORCID
  • Maksim L. Mamalyga, Dr. Med. Sci., Leading Researcher; ORCID
  • Anna G. Maksimova, Anesthesiologist-Intensivist; ORCID

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