Neurological Complications in Cardiac Surgery (original) (raw)
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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 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.
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].
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.)
Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review
International Journal of Environmental Research and Public Health, 2021
Open-heart surgery is the leading cause of neuronal injury in the perioperative state, with some patients complicating with cerebrovascular accidents and delirium. Neurological fallout places an immense burden on the psychological well-being of the person affected, their family, and the healthcare system. Several randomised control trials (RCTs) have attempted to identify therapeutic and interventional strategies that reduce the morbidity and mortality rate in patients that experience perioperative neurological complications. However, there is still no consensus on the best strategy that yields improved patient outcomes, such that standardised neuroprotection protocols do not exist in a significant number of anaesthesia departments. This review aims to discuss contemporary evidence for preventing and managing risk factors for neuronal injury, mechanisms of injury, and neuroprotection interventions that lead to improved patient outcomes. Furthermore, a summary of existing RCTs and la...
Brain complications of cardiac surgery
Current Problems in Cardiology, 1997
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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
Recognition and prevention of neurological complications in paediatric cardiac surgery
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]. Critical Care Vol 4 Suppl B Abstracts of the 2 nd International Symposium on the Pathophysiology of Cardiopulmonary Bypass References 1. Young WL, Ornstein E: Cerebral and spinal cord blood flow. In: Anesthesia and Neurosurgery. Edited by Cottrell JE, Smith DS. St. Louis, MO: Mosby, 1994:17-58. 2. Murkin JM, Farrar JK, Tweed WA, et al: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO 2 . Anesth Analg 1987, 66:825-832. 3. Hindman BJ, Funatsu N, Harrington J, et al: Cerebral blood flow response to PaCO 2 during hypothermic cardiopulmonary bypass in rabbits. Anesthesiology 1991, 75:662-668. 4. Paulson OB, Strandgaard S, Edvinsson L: Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990, 2:161-192. 5. Hindman BJ, Dexter F, Ryu KH, et al: Pulsatile versus nonpulsatile cardiopulmonary bypass. No difference in brain blood flow or metabolism at 27 degrees C. Anesthesiology 1994, 80:1137-1147. 6. Rogers AT, Prough DS, Roy RC, et al: Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 1992, 103:363-368. 7. Todd MM, Weeks JB, Warner DS: Cerebral blood flow, blood volume, and brain tissue hematocrit during isovolemic hemodilution with hetastarch in rats.