Long‐term survival and cognitive function according to blood pressure management during cardiac surgery. A follow‐up

Autor:	Lars S. Rasmussen, Volkert Siersma, Mo Haslund Larsen, J.C. Nilsson, Christina Draegert, Frederik Holmgaard, Anne G. Vedel
Rok vydání:	2020
Předmět:	Male Mean arterial pressure medicine.medical_specialty Denmark Comorbidity Logistic regression Time law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030202 anesthesiology law Internal medicine Cardiopulmonary bypass medicine Humans Cardiac Surgical Procedures Aged Intraoperative Care business.industry Hazard ratio 030208 emergency & critical care medicine General Medicine Odds ratio Middle Aged Survival Analysis Confidence interval Cardiac surgery Anesthesiology and Pain Medicine Blood pressure Cardiology Female Hypotension Cognition Disorders business Follow-Up Studies
Zdroj:	Acta Anaesthesiologica Scandinavica. 64:936-944
ISSN:	1399-6576 0001-5172
DOI:	10.1111/aas.13595
Popis:	Background Cardiac surgery is associated with a risk of complications, including post-operative cognitive dysfunction (POCD). In the randomized Perfusion Pressure Cerebral Infarcts (PPCI) trial, we allocated cardiac surgery patients to either a low-target mean arterial pressure (40-50 mm Hg) or a high-target pressure (70-80 mm Hg). The study found no difference in the volume of new ischemic cerebral lesions nor POCD, but 30-day mortality tended to be higher in the high-target group. In the present study we did a long-term 3-year follow-up to assess survival and level of cognitive functioning. The primary hypothesis was that patients allocated to a high-target blood pressure had a higher long-term mortality at 3-year follow-up. Methods We determined long-term mortality of patients included in the PPCI trial at 3-year follow-up using national registries and we assessed POCD using a cognitive test battery. Subjective level of functioning was assessed with questionnaires. POCD and subjective functioning at follow-up were evaluated in logistic regression models. Results Among the 197 patients who participated in the original study, there was no significant difference in mortality over a median of 3.4 years according to blood pressure target during cardiopulmonary bypass (hazards ratio 1.23 [high vs low] 95% confidence interval: 0.50-3.02, P = .65). POCD was found in 18.9% and 14.0% in the high-target and low-target groups, respectively adjusted odds ratio 1.01 (CI 95% 0.33-3.12). No differences were found for subjective functioning between groups. Conclusions No difference in mortality nor in the level of cognitive functioning was found according to blood pressure target during cardiac surgery long-term at 3-year follow-up.
Databáze:	OpenAIRE
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