Stroke and encephalopathy after cardiac surgery : An update

• Published in: Stroke (1970) Vol. 37; no. 2; pp. 562 - 571
• Main Authors: MCKHANN, Guy M, GREGA, Maura A, BOROWICZ, Louis M, BAUMGARTNER, William A, SELNES, Ola A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2006
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta - pathology; Biological and medical sciences; Brain Diseases - etiology; Brain Diseases - pathology; Cardiac Surgical Procedures; Cerebrovascular Circulation; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Intensive care medicine; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Postoperative Complications; Risk; Risk Factors; Stroke - etiology; Stroke - pathology; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Stroke; Nervous system diseases; Prognosis; Cardiovascular disease; coronary artery bypass; Coronary heart disease; cerebrovascular accident; Cerebral disorder; Vascular disease; brain injuries; Surgery; Encephalopathy; Central nervous system disease; outcome assessment; Cerebrovascular disease; cardiovascular surgical procedures
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000199032.78782.6c

As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery. Patients with preexisting cerebrovascular disease are at increased risk for these untoward neurological outcomes, which are associated with longer lengths of hospital stay, higher costs, and greater mortality. The mechanisms underlying these neurological events may include microemboli and hypoperfusion during surgery, and postoperative atrial fibrillation. Predictive models, based on information available before surgery, allow identification of these "high risk" patients. Establishing the degree of functionally significant vascular disease of the brain before surgery should be an essential part of the preoperative evaluation, particularly when modifications in surgical technique or novel neuroprotective agents are being evaluated.