Assessing the impact of sinus-saving modifications of carotid endarterectomy on autonomic regulation and central hemodynamics

• Main Authors: А. А. Фокин, Д. А. Борсук, В. А. Миронов, Г. А. Трейгер
• Format: Article
• Language: Russian
• Published: Meshalkin National Medical Research Center 2016-03-01
• Series: Патология кровообращения и кардиохирургия
• Subjects: каротидная эндартерэктомия; нервы каротидного синуса; артериальная гипертензия; ритмокардиография
• Online Access: http://journalmeshalkin.ru/index.php/heartjournal/article/view/259

<p><strong>Background</strong></p><p>Such complications as myocardial infarction, hyperperfusion syndrome and its effects, postoperative hematomes constitute a life-threatening event during early follow-up of carotid surgery. One of the main risk factors for these complications is a variation of central hemodynamics, especially that leading to arterial hypertension.</p><p><strong>Objective</strong></p><p>The study aimed to evaluate the safety of carotid sinus surgery as a way of preventing arterial hypertension after carotid artery reconstructions. The other objective was to compare the resultant data with the heart rate variations obtained during rhythmocardiography.<br /><strong></strong></p><p><strong>Methods</strong></p><p><strong></strong>The study focused on central hemodynamics indicators and included 290 cases. All patients were broken down in two groups. 167 patients of the first group underwent dissection of carotid sinus nerves. The carotid sinus nerves of patients from the second group (123 patients) were kept intact. Analysis of autonomic regulation of 13 patients from the first group and 17 patients from the other one was then carried out, with the heart rate variations accurately estimated at the neurocardiological laboratory.</p><p><strong>Results</strong></p><p><strong></strong>On the first postoperative day all hemodynamic indicators (such as SBP, DBP, pulse pressure, heart rate) in the second group were lower than those in the first group of patients (p&lt;0.05), while tending to recover by the third day. This fact kept postoperative complications to a minimum. The patients from the second group also demonstrated a lower activity of the sympathetic nervous system and a higher activity of the parasympathetic one. These results explain the difference between the central hemodynamic indicators in two groups.</p><p><strong>Conclusion</strong></p><p>Carotid sinus-saving surgery decreases the risk of early postoperative complications caused by arterial hypertension.</p><p> </p>