Ann Thorac Surg 2005;79:S2254-S2256
© 2005 The Society of Thoracic Surgeons
Supplement
Neuroprotection in Cardiac Surgery
William A. Baumgartner, MD*
Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
Accepted for publication February 21, 2005.
* Address reprint requests to Dr Baumgartner, Department of Surgery, The Johns Hopkins Hospital, 600 N Wolfe St, Blalock 618, Baltimore, MD 21287 (E-mail: wbaumgar@csurg.jhmi.jhu.edu).
Presented at the 4th Annual Lillehei Heart Institute Symposium Celebrating the 50th Anniversary of Open-Heart Surgery by Cross Circulation, Minneapolis, MN, Oct 19–20, 2004.
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Introduction
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Several hundred thousand patients in the United States undergo cardiac surgery. The most common procedures include those for coronary artery disease, valvular heart disease, aortic disease, surgery for heart failure, congenital heart disease, transplantation, and a variety of other combined procedures. Neurologic injury is a significant risk factor for patients undergoing cardiac surgery. Although stroke, with an incidence of 1% to 6%, is the most serious complication, cognitive impairment (25% to 65%) and impaired level of consciousness (approximately 10%) can be significantly troublesome for patients and lead to potential further complications [1]. This latter complication can consist of encephalopathy, delirium, confusion, and depression. Atherosclerotic emboli from the aorta and great vessels and hypoperfusion to watershed regions of the brain are the predominant causes of stroke (or cerebrovascular accident). The cause of cognitive impairment and impaired level of consciousness is multifactorial and has been attributed to hypoperfusion, microemboli, metabolic derangements, general anesthesia, and initiation of a proinflammatory state.
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Development of Neuroprotective Strategies
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At our institution we believe there is sufficient direct and indirect evidence to support neuroprotective strategies outlined in Table 1. The fact that the overall stroke rate for most cardiac surgical procedures has not increased during the past several years, despite a steady increase in the number of elderly patients, is in part attributed to the successful application of these strategies.
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Table 1. Neuroprotective Strategies Used in Cardiac Surgery
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The majority of these strategies are designed to reduce potential microemboli as well as relative hypoperfusion and ischemia, which could play a role in reducing overall neurologic injury, particularly that of encephalopathy. In our own experience looking at 2,244 consecutive patients (all procedures) who did not have a stroke or encephalopathy, the hospital mortality was 1.4%. Patients who . . . [Full Text of this Article]
Copyright © 2005 by The Society of Thoracic Surgeons.
