Neurological Complications of Cardiac Surgery

Abstract

Neurological injury resulting from cardiac surgery has a range of manifestations from focal neurological deficit to encephalopathy or coma. As the safety of drug-eluting stents comes into question, more patients will likely undergo coronary artery bypass graft surgery. These projections, along with the growing proportions of elderly patients and those with comorbidities, portend the potential for rising rates of perioperative neurological complications. The risk for neurological injury may be determined by the type of procedure, by patient-specific characteristics, and by the extent of cerebral embolization and hypoperfusion during and after surgery. Changes in surgical techniques, including the use of off-pump surgery, have not decreased rates of brain injury from cardiac surgery. When appropriate, modern neuroimaging techniques should be used in postoperative patients to confirm diagnosis, to provide information on potential etiology, to direct appropriate therapy, and to help in prognostication. Management of postoperative medications and early use of rehabilitation services is a recommended strategy to optimize the recovery for individuals with neurological injury after cardiac surgery.

Activities of cardiac tissue matrix metalloproteinases 2 and 9 are reduced by remote ischemic preconditioning in cardiosurgical patients with cardiopulmonary bypass

“…Cardiac surgery with cardiopulmonary bypass is generally associated with a predictable incidence of myocardial, neurological, and renal ischemia/reperfusion injury leading to an increased risk of post-operative myocardial stunning, neurological deficits, acute renal failure and as a result increased mortality [ 1 - 3 ].…”

Cardiopulmonary bypass duration is an independent predictor of adverse outcome in surgical repair for acute type A aortic dissection

“…The mechanisms underlying the correlation between CPB duration and AO remain unknown. The disadvantage of CPB is its known association with respiratory failure, myocardial, renal and neurological dysfunction and eventual organ failure [18,19]. Various measures to reduce CPB damage to the body have been employed over the past decades and have dramatically improved patient survival and reduced the incidence of other systemic complications.…”

Newly Developed Major Neurological Injury After Open Heart Surgery

“…Birçok araştırmada, kalp cerrahisi sonrası inme sıklığı araştırılmış ve %1.6 ile %4.6 arasında değişen değerler elde edilmiştir [1][2][3][4] . Tip 2 hasar ise; konfüzyon, ajitasyon, hafıza bozukluğu, fokal hasar belirtisi olmayan nöbet, nörokognitif disfonksiyon gibi standart klinik ve radyolojik bulgularla tanısı konamayan ve %50-80 gibi çok daha sık oranda karşımıza çıkan bir klinik durum kompleksidir [5,6] .…”