Central nervous system protection in cardiac surgery

Area of Science:

• Neurosurgery
• Cardiovascular Surgery
• Neurology

Background:

• Neurological dysfunction and stroke are recognized complications following cardiac and thoracic surgery involving hypothermic circulatory arrest.
• Prior stroke and lower educational attainment are identified risk factors in coronary artery bypass grafting (CABG) patients.
• Intraoperative hyperthermia and postoperative fever are linked to negative cognitive effects, while moderate glucose control is generally advised.

Purpose of the Study:

• To review the neurological complications associated with cardiac and thoracic surgery.
• To discuss cerebral protection strategies during procedures like thoracic aortic surgery.
• To highlight the need for more data on cognitive outcomes in thoracic aortic surgery patients.

Main Methods:

• Review of existing literature on neurological outcomes after cardiac and thoracic surgery.
• Analysis of risk factors and protective strategies, including hypothermic circulatory arrest, selective cerebral perfusion, and retrograde cerebral perfusion.
• Examination of evidence regarding perfusion pressures, temperature management, and glucose control.

Main Results:

• Established risk factors for neurological events include prior stroke and lower educational level.
• Higher perfusion pressures during cardiopulmonary bypass may be beneficial.
• Hyperthermia is associated with adverse cognitive outcomes; moderate glucose control is recommended.

Conclusions:

• Cerebral protection strategies are crucial, particularly in complex thoracic aortic surgery.
• While surgical outcomes are documented, cognitive outcomes following thoracic aortic surgery remain under-researched.
• Further investigation into the cognitive sequelae of thoracic aortic surgery is warranted.