Brain complications of cardiac surgery (original) (raw)
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Neurological Damage Related to Cardiac Surgery
The Neurologist, 2010
Even in milder cases, neurologic complications related to cardiac surgery increase mortality, hospitalization time, and rehabilitation costs, and so contribute to the decrease in quality of life. The incidence of neurologic complications has remained unchanged during the last years, despite age and comorbidity increasing. Improvement in technical approaches has probably contributed to maintain these percentages. Although most of the complications may be related to cardiopulmonary bypass, others factors are also involved. Identifying high risk patients could reduce incidence of complications within high risk groups, but this is probably an insufficient preventive strategy. In a population progressively older and presumably affected by an increasing number of diseases, preventive strategies should be focused on 3 aspects: first, technical improvements in cardiac surgery and cerebral protection; second, pharmacologic therapy; and, finally, identification of reliable techniques to evaluate neuropsychological dysfunction after cardiac surgery. Future efforts will be necessary to identify surrogate markers of neurologic damage and its functional outcome, perhaps related to genetic susceptibility. Only with all of these instruments, really effective preventive or palliative strategies could be planned and applied.
Neurologic complications of cardiac surgery
Progress in Cardiovascular Diseases, 2000
The average age of patients undergoing cardiac surgery and the number of comorbidities they possess will continue to increase as surgical technology advances. Toxic/metabolic encephalopathy, hemispheric strokes, hypoxic injury, and peripheral nerve lesions all can occur as a result of cardiac surgery. Therefore, an understanding of the neurologic risk, recognizable syndromes, and preventative measures will continue to be important. Careful preoperative assessment, operative risk factor reduction, and careful postoperative assessments and management may reduce the neurologic risk for cardiac surgery.
Neurological Complications in Cardiac Surgery
Complications in Cardiothoracic Surgery
Purpose of Review Perioperative neurological complications have a significant impact on mortality, morbidity, and quality of life in a growing number of high-risk patients undergoing cardiac surgery. In this comprehensive review, we provide an outline of the current literature with regard to stroke, perioperative neurocognitive disorders (delirium and cognitive decline), postoperative visual loss, and peripheral nerve injury in cardiac surgery. Recent Findings Cardiac surgeons, anesthesiologists, and critical care specialists are facing a new population of cardiosurgical patients who are older and sicker than in previous decades. If neurological complications occur during or after cardiac surgery, they may be devastating. We give insights into the etiology, underlying pathophysiologic mechanisms, incidences, and risk factors of these complications. Current international guidelines and preventive strategies are also discussed. Summary Despite technological and surgical progress aimed to reduce neurological injury in the perioperative period, neurological complications remain prevalent in cardiosurgical patients. An increased awareness of this problem will encourage appropriate risk management, frequent neurological assessments, and prompt therapeutic interventions.
Brain damage in cardiac surgery patients
Current Opinion in Pharmacology, 2012
Neuropsychological disorders and brain injury are still a serious problem in cardiac surgery patients. Owing to multifactorial mechanism of brain injury during extracorporeal circulation, the effective and safe protection is extremely difficult. Despite several studies, the ideal neuroprotective treatment has not been found. Based on literature we analysed the main mechanisms of brain injury and new methods of brain protection.
Neurological complications after cardiac surgery in adults
Critical Care, 2000
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1].
Cerebral complication after open heart surgery
1987
______________ _ (Extra-Corpor. Techno/. 19[3) p. 274-280 Fall 1987, 10 ref.) The incidence of brain complication after open heart surgery in Rajvithi Hospital has been around 2-3% each year until 1985. Since January 1986, the Capiox II membrane oxygenator has been on routine use in alternate with the Bentley bubble oxygenator. There has been increasing incidence of cerebral complication since the beginning of the year. Retrospective study is carried on to analyze brain complications after open heart surgery during January to May 1986. During this period there were 96 patients ranging in age from 9 months to 55 years, submitted for open heart surgery. Among these there were 13 patients suffering cerebral complication, namely subarachnoid or subdural hemorrhage and brain infarction, of which 6 patients died. There was no statistical significance of type of oxygenators which would cause cerebral complication. The cerebral complication was related to the weight of patients, degree of acidosis and p02 during bypass and immediately after. It is concluded that these cerebral complications could be lessened if control of blood gas and pH is optimum.
Central nervous system injury associated with cardiac surgery
Lancet, 2006
1 Cleveland JC, Shroyer LW, Chen A, Peterson E, Grover FL. Off -pump coronary artery bypass grafting signifi cantly decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282-28. 2 Roach GW, Kanchuger M, Mora-Mangano C, et al. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 1996; 335: 1857-63. 3 Boeken U, Litmathe J, Feindt P, Gams E. Neurological complications after cardiac surgery: risk factors and correlation to the surgical procedure. Thorac Cardiovasc Surg 2005; 53: 33-36. 4 Mack MJ, Brown PP, Kugelmass AD, et al. Current status and outcomes of coronary revascularization 1999 to 2002: 148 396 surgical and percutaneous procedures. Ann Thorac Surg 2004; 77: 761-66. 5 Wolman RL, Nussmeier NA, Aggarwal A, et al. Cerebral injury after cardiac surgery: identifi cation of a group at extraordinary risk. Stroke 1999; 30: 514-22. 6 Ferguson TB, Hammill BG, Peterson ED, DeLong ER, Grover FL. A decade of change-risk profi les and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Ann Thorac Surg 2002; 73: 480-89. 7 Mohan R, Amsel BJ, Walter PL. Coronary artery bypass grafting in the elderly: a review of studies on patients older than 64, 69, or 74 years. Cardiology 1992; 80: 215-25. 8 Hammermeister KE, Burchfi el C, Johnson R, Grover FL. Identifi cation of patients at greatest risk for developing major complications at cardiac surgery. Circulation 1990; 82: 380-89. 9 Jones EL, Weintraub WS, Carver JM, Guyton RA, Cohen CL. Coronary bypass surgery: Is the operation diff erent today? J Thorac Cardiovasc Surg 1991; 101: 108-15. 10 Hannen EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med 2005; 352: 2174-83. 11 Malenka DJ, Leavitt BJ, Hearne MJ, et al. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. For the northern New England cardiovascular disease study group. Circulation 2005; 112 (suppl 9): I371-76. 12 DeRose JJ Jr, Toumpoulis IK, Balaram SK, et al. Preoperative prediction of long-term survival after coronary artery bypass
2015
Although mortality rate after cardiac surgery has been drastically reduced, neurological complications remain a significant problem. Several etiologic factors have been proposed, including previous unrecognized neurological abnormality, embolic events, hypoxic insult, low cardiac output, systemic inflammatory response, and altered cerebral blood flow (CBF) and metabolism. Cerebral ischemia can occur when cerebral oxygen is insufficient to meet the global or regional cerebral oxygen consumption. Cerebral circulation is normally regulated by several complex mechanisms, such as metabolic stimuli, chemical stimuli, perfusion pressure, and neural stimuli [1].
Cerebral Injury After Cardiac Surgery : Identification of a Group at Extraordinary Risk
Stroke, 1999
Background and Purpose-Cerebral injury after cardiac surgery is now recognized as a serious and costly healthcare problem mandating immediate attention. To effect solution, those subgroups of patients at greatest risk must be identified, thereby allowing efficient implementation of new clinical strategies. No such subgroup has been identified; however, patients undergoing intracardiac surgery are thought to be at high risk, but comprehensive data regarding specific risk, impact on cost, and discharge disposition are not available. Methods-We prospectively studied 273 patients enrolled from 24 diverse US medical centers, who were undergoing intracardiac and coronary artery surgery. Patient data were collected using standardized methods and included clinical, historical, specialized testing, neurological outcome and autopsy data, and measures of resource utilization. Adverse outcomes were defined a priori and determined after database closure by a blinded independent panel. Stepwise logistic regression models were developed to estimate the relative risks associated with clinical history and intraoperative and postoperative events. Results-Adverse cerebral outcomes occurred in 16% of patients (43/273), being nearly equally divided between type I outcomes (8.4%; 5 cerebral deaths, 16 nonfatal strokes, and 2 new TIAs) and type II outcomes (7.3%; 17 new intellectual deterioration persisting at hospital discharge and 3 newly diagnosed seizures). Associated resource utilization was significantly increased-prolonging median intensive care unit stay from 3 days (no adverse cerebral outcome) to 8 days (type I; PϽ0.001) and from 3 to 6 days (type II; PϽ0.001), and increasing hospitalization by 50% (type II, Pϭ0.04) to 100% (type I, PϽ0.001). Furthermore, specialized care after hospital discharge was frequently necessary in those with type I outcomes, in that only 31% returned home compared with 85% of patients without cerebral complications (PϽ0.001). Significant risk factors for type I outcomes related primarily to embolic phenomena, including proximal aortic atherosclerosis, intracardiac thrombus, and intermittent clamping of the aorta during surgery. For type II outcomes, risk factors again included proximal aortic atherosclerosis, as well as a preoperative history of endocarditis, alcohol abuse, perioperative dysrhythmia or poorly controlled hypertension, and the development of a low-output state after cardiopulmonary bypass. Conclusions-These prospective multicenter findings demonstrate that patients undergoing intracardiac surgery combined with coronary revascularization are at formidable risk, in that 1 in 6 will develop cerebral complications that are frequently costly and devastating. Thus, new strategies for perioperative management-including technical and pharmacological interventions-are now mandated for this subgroup of cardiac surgery patients. (Stroke. 1999;30:514-522.)