Neurological damage related to open-heart surgery: A clinical survey

Abstract

A survey has been carried out on all cases submitted to open-heart surgery at one hospital during 1970 to determine which operative features were associated with the occurrence of neurological damage.Four hundred and seventeen subjects survived the operative period. Neurological dysfunction, defined as impairment of consciousness, voluntary movement or vision, apparent within three days of operation, was noted in 80 patients (19-2%). Twenty-one of these 80 patients died in the postoperative period, neurological damage contributing to the fatal outcome in 11 cases. The remaining 59 patients survived to leave hospital but 17 were left with some residual neurological disability.A number of features were found to be positively correlated with the development of neurological damage when considered alone, but multiple regression analysis revealed that only three factors were significantly associated, independent of all other variables. These factors were age, duration of perfusion, and a history of previous neurological disorder.The use of a Temptrol oxygenator was associated with a lower incidence of neurological dysfunction to a degree which was probably significant (P<0 02). The small number of patients perfused with the Temptrol oxygenator (30 cases) reduces the clinical importance of this finding.Neurological damage continues to occur following open-heart surgery in spite of changes in both the nature and technique of operation and the method of perfusion.The reported incidence varies (Gilman, 1965;Sachdev, Carter, Swank, and Blachly, 1967;Javid et al., 1969) Jacobson, 1960;Paton, Pearcy, and Swan, 1960;Hasbrouck and Rigor, 1969;Magner, 1971). Profound hypothermia (Bjork and Hultquist, 1960;Drew, 1961)

Epileptic Seizures Due to Thrombotic and Embolic Cerebrovascular Disease in Older Patients

“…In this study plus four others (Branthwaite, 1972(Branthwaite, , 1973Casteneda et al, 1974;Stockard et al, 1974), seizures occurred in 21 of 900 patients. Suggested causes of neurologic deficits of any kind after cardiac surgery have included age (Tufo et al, 1970;Branthwaite, 1973;Stockard et al, 1973), atherosclerosis (Branthwaite, 1973;Stockard et al, 1973;Bojar et al, 1983), perfusion duration (Tufo et al, 1970;Branthwaite, 1973;Aberg and Kihlgren, 1977), toxins (Dobell et al, 1966;Stockard et al, 1974), metabolic changes (Fischer-Williams and Cooper, 1964), alveolar collapse (Fischer-Williams and Cooper, 1964), use of all blood primers (Branthwaite, 1973), emboli whether due to atheromata or air (Brierley, 1964;Aberg and Kihlgren, 1977;Bojar et al, 1983), and hypotension with or without decreased cardiac output (Brierley, 1964;Fischer-Williams and Cooper, 1964;Tufo et al, 1970;Castaneda et al, 1974;Bojar et al, 1983;Breuer et al, 1983).…”

Cerebral protection during open-heart surgery.

“…Mean arterial pressure during perfusion (Javid et al, 1969), the patient's age, duration of perfusion, and a history of previous neurological damage (Branthwaite, 1972) have all been related to the occurrence of postoperative neurological dysfunction.…”

“…In the past, reports have been published describing large series of patients with a very high incidence of cerebral complications (Tufo et al, 1970;Lee et al, 1971;Branthwaite, 1972). It seems clear that many of these injuries are preventable and that the goal must be to eliminate all cerebral damage during cardiopulmonary bypass (Patrick et al, 1958).…”

Cerebral perfusion during major cardiac surgery in children

“…Infusion of prostacyclin during CPB may represent a powerful pharmacological approach to reduce microembolism during cardiac surgery [21,31] . Cerebral hypoperfusion due to arterial hypotension is another causative mechanism proposed by several authors [9,11,16,34,35], but denied by others [4,17] .…”