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Prevention of perioperative neurological dysfunction. A six year perspective of cardiac surgery
I Fessatidis1, S Prapas, A Hevas
1Cardiac Surgery Center of Northern Greece, G. Papanikolaou General Hospital, Thessaloniki.
Insights
Implementing specific protocols for cardiac surgery reduced major neurological complications. Protocols addressed heart-lung machine use, air embolism, and cerebrovascular disease, leading to a 1.08% incidence of neurological syndromes.
Area of Science:
- Cardiology
- Neurology
- Surgical Complications
Background:
- Neurological dysfunction is a recognized complication of cardiac surgery.
- Potential causes include heart-lung machine issues, emboli, and cerebrovascular disease.
Purpose of the Study:
- To minimize serious neurological complications following cardiac surgery.
- To investigate the incidence and causes of perioperative stroke.
Main Methods:
- Instituted protocols targeting heart-lung machine components, air evacuation, and pharmacological brain protection.
- Applied protocols during 1487 consecutive cardiac surgical procedures (1984-1989).
Main Results:
- 16 patients (1.08%) suffered major neurological syndromes.
- Identified 4 groups: unresponsive, focal infarction, delayed deficits, and mental aberration.
- Suspected embolic events and hypotension in 75% of affected patients.
- Poor outcomes observed in unresponsive patients, with 56.6% mortality or coma.
Conclusions:
- Protocols for cardiac surgery can help minimize neurological dysfunction.
- Embolic events and hypotension are significant suspected causes of perioperative stroke.
- Neurological complications significantly impact patient outcomes.
Abstract:
Neurological dysfunction following cardiac surgical procedures is now well recognized. In order to minimise this serious complication, we instituted various protocols related to the potential causes of perioperative stroke such as: (1) components and use of the heart-lung machine; (2) air embolization; (3) intrinsic cerebro-vascular disease; (4) atheroemboli from the ascending aorta and (5) clot emboli from the left ventricle. We employed certain methods of operation of the heart-lung machine, air evacuation manoeuvres and a pharmacological brain protection protocol. These protocols were applied in a series of 1487 consecutive cardiac surgical procedures performed between 1984 and 1989; 127 patients died (8.54% mortality) and 16 patients (1.08%) suffered major neurological syndromes. Among the latter patients, 4 distinct groups were identified. Group A consisted of 6 patients who remained unresponsive after operation. In group B were 6 patients who awakened after operation but had clinical evidence of focal cerebral infarction. Group C included 3 patients who were initially intact neurologically but in whom neurological deficits developed later. Group D contained 1 patient who had severe mental aberration but no focal neurological deficits. Causative factors, including atheromatous embolism, perioperative hypotension and air embolism, were suspected in 12 of these 16 patients (75%) in groups A, B and C. The outcome was poor for unresponsive patients and 9 out of the 16 died or remained comatose (56.6%).