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[Cerebral complication during open heart surgery in relation to cerebral arterial stenosis documented by angiography]
Insights
Preoperative assessment of carotid artery stenosis in elderly patients undergoing open heart surgery can identify those at higher risk for cerebral complications. Complete internal carotid artery occlusion significantly increases this risk.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Vascular Imaging
Background:
- Open heart surgery carries a risk of cerebral lesions.
- Elderly patients and those with a history of cerebrovascular disease (CVD) are particularly vulnerable.
Purpose of the Study:
- To identify risk factors for postoperative cerebral complications after open heart surgery.
- To evaluate the role of preoperative cranial angiography in assessing these risks.
Main Methods:
- Cranial 4-vessel angiography was performed on 89 high-risk patients before surgery.
- Patients were categorized based on significant arterial stenosis (>75% or complete obstruction).
- An additional 479 patients were analyzed for risk factors like age, CVD history, and extracorporeal circulation (ECC) time.
Main Results:
- 19% of patients had significant carotid artery stenosis, with 6 having complete internal carotid artery occlusion.
- Seven patients (7.9%) experienced postoperative neurological complications; four had significant stenosis, three with complete internal carotid artery occlusion.
- Complete internal carotid artery occlusion was a significant predictor of cerebral complications (p < 0.013).
- Advanced age and a history of CVD were significant risk factors for neurological complications (p = 0.044 and p < 0.001, respectively).
- Longer ECC times (>120 minutes) showed a tendency towards complications in high-risk patients (p = 0.045).
Conclusions:
- Preoperative angiography, particularly identifying complete internal carotid artery occlusion, is crucial for risk stratification in open heart surgery patients.
- Age and prior CVD history are key patient factors influencing postoperative neurological outcomes.
- While ECC time may not be a universal risk factor, it warrants consideration in prolonged procedures for high-risk individuals.
Abstract:
To determine the cause of a cerebral lesion after open heart surgery, a cranial 4-vessel-study was performed prior to an elective operation in 89 patients, who were over 70 years of age and/or had a previous history of cerebro-vascular diseases (CVD). Patients with arterial stenosis over 75% to complete obstruction were categorized as the significant stenosis group and the others as the normal findings group. Of the 89 cases, 19 (21.1%) showed significant stenosis, among which six patients were found to have complete occlusion of the internal carotid artery. Seven patients (7.9%) developed postoperative neurological complications, with four patients having single or plural significant stenosis. Angiograms of three of those four patients revealed complete obstruction of their internal carotid arteries. The stenotic group showed a tendency toward neurological complications in comparison with the non-stenotic group although the incidence was not significant (p = 0.054). However analysis of the group with complete occlusion of the internal carotid artery indicated significant increased risk for cerebral complication (p < 0.013). Besides the 89 patients studied, an additional 479 patients who had not undergone preoperative angiography were subjected to this study whether the patient's age, previous history of CVD and extracorporeal circulation (ECC) time or aortic cross-clamp time were of the risk factors for postoperative cerebral complications or not. There was significant correlation between age (p = 0.044) and/or the previous history of CVD (p < 0.001) and neurological complications. Although there was no correlation between either the duration of ECC or aortic cross-clamp time and neurological problems within the whole study population, when only the patients over 70 years old and/or having history of CVD were studied, an increased tendency towards neurological complications was seen when the ECC time was longer than 120 minutes (p = 0.045).