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Published on: March 26, 2018
Link Between Cardiovascular and Cerebrovascular Controls in Patients Undergoing Surgical Aortic Valve Replacement
Insights
Cardiovascular and cerebrovascular regulation interplay after surgery. Impaired baroreflex control post-surgery may be compensated by enhanced cerebral autoregulation, crucial for patient recovery.
Area of Science:
- Cardiovascular physiology
- Autonomic nervous system function
- Cerebrovascular regulation
Background:
- Autonomic influence on cardiovascular (CV) and cerebrovascular (CBV) regulation is known but poorly understood in pathological states.
- Surgical aortic valve replacement (SAVR) presents a unique model to study these interactions.
Purpose of the Study:
- To investigate the correlation between CV and CBV markers in patients undergoing SAVR.
- To assess changes in CV and CBV regulation before, immediately after, and 3 months post-surgery.
Main Methods:
- Frequency domain analysis (transfer function gain, phase, squared coherence) was used to assess CV and CBV control.
- Measurements were taken before (PRE), within 1 week (POST), and 3 months (POST3) after SAVR, with and without orthostatic challenge.
- Correlation analysis was performed between CV and CBV control indices.
Main Results:
- CV control was impaired PRE, worsened POST, and recovered POST3; CBV markers remained relatively unchanged.
- A significant positive relationship was found between CV and CBV markers, particularly POST and POST3.
- This suggests a compensatory interplay between baroreflex and cerebral autoregulation.
Conclusions:
- The relationship between CV and CBV controls is vital for patients undergoing SAVR.
- Impaired baroreflex control post-SAVR may be compensated by more efficient cerebral autoregulation.
- Maintaining this relationship is fundamental for preventing adverse outcomes.
Abstract:
Although the autonomic influence on cardiovascular (CV) and cerebrovascular (CBV) regulations has been widely recognized, their relationship is poorly explored especially in pathological situations. This study investigates the correlation between CV and CBV markers in 73 patients (48 males, age 63.6±13.1 yrs) undergoing surgical aortic valve replacement (SAVR) evaluated before the intervention (PRE), within 1-week post-surgery (POST) and after a 3-month follow-up (POST3). Patients were acquired before and after an orthostatic challenge. Frequency domain analysis assessing transfer function gain (TFG), phase (Ph), and squared coherence (K2) between heart period and systolic arterial pressure was exploited to evaluate CV control. The same frequency domain functions were derived to assess CBV regulation from mean cerebral blood velocity and mean arterial pressure. A correlation analysis between indexes of CV and CBV controls was carried out. Results showed that CV control was impaired in PRE, worsened in POST, and recovered in POST3, while CBV markers were almost unchanged. A significant positive relationship between CV and CBV markers was observed, especially in POST and POST3, thus suggesting that the compensation of a baroreflex impairment with a more efficient CBV control and vice versa. The maintenance of this relationship between CV and CBV controls in patients undergoing SAVR could be fundamental to prevent risky situations.Clinical Relevance- After surgical aortic valve replacement an impaired baroreflex control could be compensated by a more efficient cerebral autoregulation.
