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Neurological complications of cardiac surgery
Rebecca F Gottesman1, Guy M McKhann, Charles W Hogue
1Department of Neurology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA. rgottesm@jhmi.edu
Insights
Neurological injury after cardiac surgery is a growing concern, influenced by patient factors and surgical procedures. Early diagnosis with neuroimaging and rehabilitation are key to optimizing patient recovery.
Area of Science:
- Neurology
- Cardiology
- Neurosurgery
Background:
- Neurological injury following cardiac surgery presents diverse symptoms, from focal deficits to coma.
- Increasing coronary artery bypass graft surgeries and an aging population with comorbidities may elevate perioperative neurological complication rates.
- Current surgical advancements like off-pump surgery have not reduced brain injury incidence.
Purpose of the Study:
- To review the causes and management of neurological injury after cardiac surgery.
- To highlight the role of neuroimaging in diagnosis and prognostication.
- To recommend strategies for optimizing patient recovery.
Main Methods:
- Literature review focusing on perioperative neurological complications in cardiac surgery.
- Analysis of factors contributing to neurological injury, including procedural type, patient characteristics, and cerebral events.
- Discussion of diagnostic and therapeutic approaches.
Main Results:
- Neurological injury risk is multifactorial, involving surgical procedure, patient specifics, and cerebral embolization/hypoperfusion.
- Neuroimaging is crucial for accurate diagnosis, etiological insight, treatment guidance, and prognosis.
- Postoperative medication management and early rehabilitation are vital for recovery.
Conclusions:
- Neurological complications post-cardiac surgery require careful consideration due to increasing patient risk factors.
- Integrated management involving advanced diagnostics and timely rehabilitation is essential for improving outcomes.
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.
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