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Neuroprotection against stroke and encephalopathy after cardiac surgery
Daniel G Jovin1, Karl G Katlaps1, Ben K Ellis1
1Cardiothoracic Research, Department of Surgery, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
Insights
Perioperative neuroprotection strategies are crucial for preventing stroke and cognitive decline after cardiothoracic surgery. While many methods show promise in animal models, clinical evidence for their effectiveness is often limited, necessitating further research.
Area of Science:
- Neurosurgery
- Cardiology
- Critical Care Medicine
Background:
- Cerebral ischemia during cardiothoracic surgery increases risks of stroke, encephalopathy, and cognitive decline.
- These neurological complications significantly worsen patient outcomes and mortality rates.
Purpose of the Study:
- To review the importance and necessity of neuroprotection in cardiothoracic surgery.
- To evaluate the efficacy of various neuroprotective agents and methods, focusing on clinical data.
Main Methods:
- Literature review of experimental and clinical studies on neuroprotection.
- Emphasis on agents and methods with clinical trial data relevant to cardiothoracic surgery.
Main Results:
- Some neuroprotective agents show efficacy in preclinical models but lack robust clinical validation.
- Clinical research is often insufficient or has yielded disappointing results for many interventions.
Conclusions:
- Neuroprotection is vital in cardiothoracic surgery to mitigate neurological injury.
- More well-designed clinical trials are needed to establish effective neuroprotective strategies for patients.
Abstract:
Cerebral ischemia in the perioperative period is a major risk factor for stroke, encephalopathy, and cognitive decline after cardiothoracic surgery. After coronary artery bypass grafting, both stroke and encephalopathy can result in poor patient outcomes and increased mortality. Neuroprotection aims to lessen the severity and occurrence of further injury mediated by stroke and encephalopathy and to aid the recovery of conditions already present. Several pharmacological and non-pharmacological methods of neuroprotection have been investigated in experimental studies and in animal models, and, although some have shown effectiveness in protection of the central nervous system, for most, clinical research is lacking or did not show the expected results. This review summarizes the value and need for neuroprotection in the context of cardiothoracic surgery and examines the use and effectiveness of several agents and methods with an emphasis on clinical trials and clinically relevant neuroprotectants.
