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Long-term survival and cognitive function according to blood pressure management during cardiac surgery. A follow-up
Mo H Larsen1, Christina Draegert1, Anne G Vedel1,2
1Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Maintaining a high-target blood pressure during cardiac surgery did not affect long-term mortality or cognitive function 3 years later. This study found no significant differences in survival or post-operative cognitive dysfunction (POCD) between high-target and low-target pressure groups.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Cardiac surgery carries risks, including post-operative cognitive dysfunction (POCD).
- The initial Perfusion Pressure Cerebral Infarcts (PPCI) trial compared low-target (40-50 mm Hg) versus high-target (70-80 mm Hg) mean arterial pressure during surgery.
- The PPCI trial found no difference in new ischemic cerebral lesions or POCD, but a trend towards higher 30-day mortality in the high-target group.
Purpose of the Study:
- To assess long-term survival up to 3 years after cardiac surgery.
- To evaluate the long-term level of cognitive functioning in patients based on intraoperative blood pressure targets.
- To test the hypothesis that a high-target blood pressure during surgery increases long-term mortality.
Main Methods:
- A 3-year follow-up of patients from the PPCI trial was conducted.
- Long-term mortality was determined using national registries.
- Post-operative cognitive dysfunction (POCD) and subjective functioning were assessed using cognitive test batteries and questionnaires.
Main Results:
- No significant difference in mortality was observed between the high-target and low-target blood pressure groups over a median of 3.4 years (HR 1.23; 95% CI: 0.50-3.02).
- The incidence of POCD was similar between groups (18.9% high-target vs. 14.0% low-target; aOR 1.01; 95% CI: 0.33-3.12).
- No differences were found in subjective functioning between the two blood pressure target groups.
Conclusions:
- Intraoperative mean arterial pressure targets during cardiac surgery do not significantly impact long-term mortality.
- Cognitive functioning and subjective level of functioning at 3-year follow-up are not affected by the blood pressure target used during cardiac surgery.
- These findings suggest that current blood pressure management strategies in cardiac surgery are appropriate for long-term patient outcomes.
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.
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