Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study
Objective To evaluate the impact of intraoperative neuromonitoring (IONM) on stroke and operative mortality after coronary and/or valvular operations.Methods This was an observational study of coronary and/or valvular heart operations from 2010 to 2021. Baseline characteristics and postoperative out...
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BMJ Publishing Group
2024-11-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/11/2/e002939.full |
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| author | James Brown Kathirvel Subramaniam Sarah Yousef Ibrahim Sultan Nidhi Iyanna Derek Serna-Gallegos Jianhui Zhu Pyongsoo Yoon David Kaczorowski Johannes Bonatti Danny Chu Jeffrey Balzer Parthasarathy D Thirumala |
| author_facet | James Brown Kathirvel Subramaniam Sarah Yousef Ibrahim Sultan Nidhi Iyanna Derek Serna-Gallegos Jianhui Zhu Pyongsoo Yoon David Kaczorowski Johannes Bonatti Danny Chu Jeffrey Balzer Parthasarathy D Thirumala |
| author_sort | James Brown |
| collection | DOAJ |
| description | Objective To evaluate the impact of intraoperative neuromonitoring (IONM) on stroke and operative mortality after coronary and/or valvular operations.Methods This was an observational study of coronary and/or valvular heart operations from 2010 to 2021. Baseline characteristics and postoperative outcomes were compared by the use or non-use of IONM, which included both electroencephalography and somatosensory-evoked potentials. Propensity-score matching was employed to assess the association of IONM usage with operative mortality and stroke.Results A total of 19 299 patients underwent a cardiac operation, of which 589 (3.1%) had IONM. Patients with IONM were more likely to have had baseline cerebrovascular disease (60% vs 22%). Patients with IONM had increased operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%). Moreover, stroke and mortality were highly correlated, with 14% of strokes resulting in death, while only 2% of non-strokes resulted in death (p<0.001). The unadjusted Kaplan-Meier survival estimate was significantly lower among the group with IONM (p<0.001, log-rank). After propensity matching, however, there was no difference in operative mortality or stroke across each group: 3.6% vs 5.3% for mortality and 3.7% vs 5.4% for stroke. In the propensity-matched cohort, the Kaplan-Meier survival estimates were not significantly different across each group (p=0.419, log-rank).Conclusions Adjusting for baseline risk, there was no significant difference in adverse outcomes across each group. IONM may serve as a biomarker of cerebral ischaemia, and empirical adjustments based on changes may provide benefits for neurologic outcomes in high-risk patients. The efficacy of IONM during cardiac surgery should be prospectively validated. |
| format | Article |
| id | doaj-art-f2e0faccaf6b41438dca09751591c891 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-f2e0faccaf6b41438dca09751591c8912024-11-12T20:55:08ZengBMJ Publishing GroupOpen Heart2053-36242024-11-0111210.1136/openhrt-2024-002939Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort studyJames Brown0Kathirvel Subramaniam1Sarah Yousef2Ibrahim Sultan3Nidhi Iyanna4Derek Serna-Gallegos5Jianhui Zhu6Pyongsoo Yoon7David Kaczorowski8Johannes Bonatti9Danny Chu10Jeffrey Balzer11Parthasarathy D Thirumala12Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UKUPMC, Pittsburgh, Pennsylvania, USADepartment of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, Sharjah, UAE1 Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USADivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USAUPMC, Pittsburgh, Pennsylvania, USACenter for Clinical Neurophysiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USANeurosurgery and Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAObjective To evaluate the impact of intraoperative neuromonitoring (IONM) on stroke and operative mortality after coronary and/or valvular operations.Methods This was an observational study of coronary and/or valvular heart operations from 2010 to 2021. Baseline characteristics and postoperative outcomes were compared by the use or non-use of IONM, which included both electroencephalography and somatosensory-evoked potentials. Propensity-score matching was employed to assess the association of IONM usage with operative mortality and stroke.Results A total of 19 299 patients underwent a cardiac operation, of which 589 (3.1%) had IONM. Patients with IONM were more likely to have had baseline cerebrovascular disease (60% vs 22%). Patients with IONM had increased operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%). Moreover, stroke and mortality were highly correlated, with 14% of strokes resulting in death, while only 2% of non-strokes resulted in death (p<0.001). The unadjusted Kaplan-Meier survival estimate was significantly lower among the group with IONM (p<0.001, log-rank). After propensity matching, however, there was no difference in operative mortality or stroke across each group: 3.6% vs 5.3% for mortality and 3.7% vs 5.4% for stroke. In the propensity-matched cohort, the Kaplan-Meier survival estimates were not significantly different across each group (p=0.419, log-rank).Conclusions Adjusting for baseline risk, there was no significant difference in adverse outcomes across each group. IONM may serve as a biomarker of cerebral ischaemia, and empirical adjustments based on changes may provide benefits for neurologic outcomes in high-risk patients. The efficacy of IONM during cardiac surgery should be prospectively validated.https://openheart.bmj.com/content/11/2/e002939.full |
| spellingShingle | James Brown Kathirvel Subramaniam Sarah Yousef Ibrahim Sultan Nidhi Iyanna Derek Serna-Gallegos Jianhui Zhu Pyongsoo Yoon David Kaczorowski Johannes Bonatti Danny Chu Jeffrey Balzer Parthasarathy D Thirumala Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study Open Heart |
| title | Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study |
| title_full | Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study |
| title_fullStr | Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study |
| title_full_unstemmed | Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study |
| title_short | Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study |
| title_sort | intraoperative neurophysiologic monitoring during cardiac surgery an observational cohort study |
| url | https://openheart.bmj.com/content/11/2/e002939.full |
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