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[Cerebral insult in heart surgery]
L Egloff1, A Laske, R Siebenmann
1HerzZentrum Hirslanden, Zürich.
Insights
Perioperative stroke in cardiac surgery is often caused by emboli. Combining carotid endarterectomy with cardiac surgery may reduce major neurologic complications.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Context:
- Cardiac surgery carries a risk of perioperative stroke.
- Identifying stroke etiology is crucial for prevention.
- 3593 adult open-heart operations were analyzed.
Purpose:
- To identify causes of perioperative stroke in cardiac surgery.
- To reduce the incidence of stroke following cardiac procedures.
Summary:
- 68 focal strokes (2%) occurred, with 13 fatal outcomes.
- Major stroke causes included aortic emboli, cardiac thrombi, and carotid stenosis.
- Combined carotid endarterectomy and cardiac surgery showed no major neurologic complications.
Impact:
- Preoperative neuroangiologic assessment and echocardiography are recommended.
- Careful intraoperative management can identify and mitigate embolic sources.
- Simultaneous endarterectomy for high-grade carotid stenosis is advised.
Abstract:
The aim of the study was to identify causes for perioperative stroke in cardiac surgery in order to reduce its occurrence. From 1989 to 1994, 3593 open heart operations were performed in adult patients. In 59 patients carotid endarterectomy for high grade stenosis was combined with the cardiac operation. There were a total of 68 (2%) focal strokes, 41 of which were considered minor and 14 major; 13 were lethal. The etiology of the 27 major and lethal events was most probably an embolus from the ascending aorta (6), from the ascending aorta or a cardiac valve (5), a thrombus in the left heart (6), air (1), cardiac arrest and resuscitation (4), cerebral hemorrhage (1), preoperatively unknown but high grade internal carotid stenosis (3), and a 50% stenosis of both internal carotid arteries preoperatively known but not operated on (1). There were 2 minor but no major neurologic complications in patients undergoing a combined carotid and cardiac procedure. A wide indication for preoperative neuroangiologic examination, echocardiography and careful intraoperative management may help to identify sources of possible emboli. Endarterectomy of high grade carotid stenosis is recommended simultaneously with the cardiac procedure.