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[Neurologic events after heart surgery: the need for a more thorough preoperative assessment]
S Urbinati1, M G Poci, G Pinelli
1Unità Operativa di Cardiologia, Ospedale Bellaria, Bologna.
Insights
Neurologic complications after cardiac surgery, including stroke and cognitive decline, affect nearly 16% of patients. Preoperative risk assessment and tailored surgical strategies are crucial for prevention and management.
Area of Science:
- Neurology
- Cardiology
- Vascular Surgery
Context:
- Neurologic complications following cardiac surgery are increasingly recognized.
- Factors contributing to this rise include an aging patient population, increased aortic valve replacements, and improved diagnostics for cerebral ischemia.
- Embolic mechanisms are implicated in the majority of cases, leading to transient ischemic attacks (TIA), ischemic stroke, cognitive defects, and seizures.
Purpose:
- To highlight the rising incidence and types of neurologic complications post-cardiac surgery.
- To emphasize the necessity of systematic preoperative evaluation for risk stratification.
- To advocate for individualized surgical strategies based on preoperative findings.
Summary:
- The prevalence of neurologic complications after cardiac surgery is approximately 16%.
- These complications manifest as Type I (TIA, ischemic stroke) and Type II (cognitive defects, seizures) outcomes.
- Preoperative assessments such as echocardiography and carotid Doppler ultrasound are vital for identifying high-risk patients.
Impact:
- Implementing preoperative risk stratification and careful postoperative monitoring can prevent and better manage neurologic complications.
- Personalized surgical approaches, including off-pump surgery, can mitigate risks for specific patient groups.
- Early detection and intervention can improve patient outcomes and reduce long-term morbidity.
Abstract:
The occurrence of neurologic complications after cardiac surgery varies widely and has increased during the last years for several reasons: older age of patients, higher prevalence aortic valve replacement, and more careful diagnosis of cerebral ischemia. Recent studies showed that embolic mechanism is involved in most patients, and two main clinical outcomes are detectable: type I outcome, consisting of TIA and ischemic stroke, and type II outcome, consisting of cognitive defects and seizures. The overall prevalence of neurologic complications after cardiac surgery is nearly 16% and suggests the need of systematic preoperative evaluation of patients for identifying those with high risk and the individualization of the surgical strategy. The preoperative work-up should include two-dimensional echocardiography, transesophageal echocardiography (for detecting patients with ascending aortic lesion who need alternative surgical strategies, i.e. different site of cross clamping, cannulation, and proximal anastomosis of the venous graft), Doppler ultrasound of carotid arteries (for identifying those candidates to combined surgery), and psychobehavioural evaluation (for selecting patients with cognitive deterioration who could be treat by off-pump surgery). In conclusion, a preoperative stratification of the neurologic risk, and a more careful postoperative monitoring should be mandatory for preventing and adequately treating neurologic complications of cardiac surgery.