Central Nervous System Complications After Cardiac Surgery

Abstract

Central nervous system (CNS) complications (disturbance of consciousness, focal motor deficits, and seizures) after coronary artery bypass grafting (CABG) and cardiac valve surgery were studied retrospectively. The incidence of CNS complications was significantly more frequent in CABG (11%, 71/638) than in valve surgery (7%, 24/345). Major contributory factors of CNS complications were preexisting cerebrovascular disease and cardiopulmonary bypass time. In comparison to previous reports, older age, hypertension, diabetes mellitus, and cerebrovascular disease were more common in the patients undergoing CABG. The preexisting cerebrovascular disease and prolonged cardiopulmonary bypass time probably increase the risk of cerebral embolism and/or cerebral hypoperfusion. We conclude that patients undergoing CABG surgery are at greater risk for neurological damage in comparison to those undergoing valve surgery.

Neuroprotective Effect of Low Mean Arterial Pressure on Postoperative Cognitive Deficit Attenuated by Prolonged Coronary Artery Bypass Time: A Meta-Analysis

“…Other studies also support this finding, implying that prolonged CPB time is related to an increasing embolic load [3,23] . The pivotal role of surgery time in CABG patients has fully been understood in the literature [23-25] . Brown et al [3] reported that each 60-minute increase in CPB time associates with 30.5% increase in the embolic burden.…”

Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery

“…Postoperative neurological dysfunction is a major cause of morbidity after cardiac surgery and occurs in 1%-11% of patients [5][6][7][8][9]. Postoperative neurological dysfunction is a major cause of morbidity after cardiac surgery and occurs in 1%-11% of patients [5][6][7][8][9].…”

A Review of Risk Factors for Adverse Neurologic Outcome After Cardiac Surgery

“…According to recent prospective studies, perioperative overt stroke occurs in approximately 1-4% of patients who undergo isolated coronary artery bypass grafting (CABG) (1)(2)(3)(4)(5)(6)(7)(8). Although the incidence of overt sequelae has traditionally been higher in patients undergoing such isolated intracardiac procedures as valve replacement or repair (9)(10)(11)(12)(13), recent studies show that the incidence of stroke for intracardiac procedures now approximates that for isolated CABG (14)(15)(16)(17). In both intracardiac and extracardiac surgery, macroemboli (>200 m in diameter) and microemboli (<40 m in diameter) seem to be responsible for most neurologic complications (1-9, 11, 14, 15, 18).…”