Download PDF
Thorac Cardiovasc Surg 2005; 53(1): 33-36
DOI: 10.1055/s-2004-830426
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Neurological Complications After Cardiac Surgery: Risk Factors and Correlation to the Surgical Procedure[1]

U. Boeken1 , J. Litmathe1 , P. Feindt1 , E. Gams1
  • 1Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
Further Information

Publication History

Received April 28, 2004

Publication Date:
03 February 2005 (online)

    Permissions and Reprints All articles of this category

Abstract

Objective: The aim of our study was to analyze risk factors for neurological complications in a group of patients undergoing cardiac operations. Methods: We analyzed 783 consecutive patients undergoing cardiac surgery in 2001. Group I consisted of 582 patients with a CABG procedure, group II patients underwent a single valve replacement (n = 101), group III had a combined procedure (CABG + valve) (n = 70), and group IV patients underwent multi-valve procedure (n = 30). Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors for neurological complications (reversible deficits and strokes). Results: The incidence of perioperative neurological problems was 1.7 % in the CABG group, 3.6 % in group II, 3.3 % in group III, and 6.7 % in group IV. With multivariate analysis we could identify various parameters as independent risk factors: previous neurological events, advanced age, and the time of aortic cross-clamping correlated with the incidence of perioperative neurological complications. In addition, we found a predictive value for preoperative anemia, the number of bypasses, an ejection fraction < 0.35 and for insulin-dependent diabetes mellitus. The duration of extracorporeal circulation and the fact of an re-operation could not be identified as risk factors. Conclusion: Our results show that type of surgery, symptomatic cerebrovascular disease, advanced age, diabetes mellitus, and probably aortic atheroma represent the most important risk factors for neurological complications. After preoperative consideration of the individual risk of each patient, neuroprotective interventions (arterial line filtration, alpha-stat management) and pharmacological neuroprotection may offer an improved outcome to some of these “high-risk” patients.

Key words

Neurological complication - open heart surgery - cerebrovascular disease - risk-stratification

1 The results of this paper were presented in part during the 4th joint meeting of the Austrian, Swiss and German Society of Thoracic and Cardiovascular Surgery in Hamburg, Germany, February 15 - 18, 2004

References

  • 1 Shaw P J, Bates D, Cartliege N EF. Neurologic and neuropsychologic morbidity following major surgery: Comparison of coronary artery bypass and peripheral vascular surgery.  Stroke. 1987;  18 700-707
    PubMedGoogle Scholar
  • 2 Barbut D, Lo Y J, Gold J P, Trifiletti R R, Frank Yao F S, Hager D N, Hinton R B, Wayne Isom O. Impact of embolization during coronary artery bypass grafting on outcome and length of stay.  Ann Thorac Surg. 1997;  63 998-1002
    CrossrefPubMedGoogle Scholar
  • 3 Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning.  Stroke. 1994;  25 1393-1395
    PubMedGoogle Scholar
  • 4 Padayachee T S, Parsons S, Theobol R, Lindley J, Gosling R G, Deverall P B. The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: A transcranial Doppler ultrasound investigation using membrane and bubble oxygenators.  Ann Thorac Surg. 1987;  44 298-302
    PubMedGoogle Scholar
  • 5 Blauth C, Smith P, Newman S, Arnold J, Siddons F, Harrison M J, Treasure T, Klinger L, Taylor K M. Retinal microembolism and neuropsychological deficit following clinical cardiopulmonary bypass: Comparison of a membrane and a bubble oxygenator.  Eur J Cardiothor Surg. 1989;  3 135-139
    PubMedGoogle Scholar
  • 6 Hosoda Y, Watanabe M, Hirooka Y, Ohse Y, Tanaka A, Watanabe T. Significance of arteriosclerotic changes of the ascending aorta during coronary bypass surgery with intraoperative detection by echography.  J Cardiovasc Surg. 1991;  32 301-306
    PubMedGoogle Scholar
  • 7 Cernaianu A C, Vassilidze T V, Flum D R, Maurer M, Cilley J H, Grosso M A, Del Rossi A AJ. Predictors of stroke after cardiac surgery.  J Card Surg. 1995;  10 334-339
    CrossrefPubMedGoogle Scholar
  • 8 Barbut J, Gold P J. Aortic atheromatosis and risks of cerebral embolisation.  J Cardiothorac Vasc Anesth. 1996;  10 24-30
    PubMedGoogle Scholar
  • 9 Jones E L, Weintraub W S, Craver J M, Guyton R A, Cohen C L. Coronary bypass surgery: Is the operation different today?.  J Thorac Cardiovasc Surg. 1991;  101 108-115
    PubMedGoogle Scholar
  • 10 Roach G W, Kanchuger M, Mangano C. Adverse outcomes after coronary artery bypass surgery.  N Engl J Med. 1996;  335 1857-1863
    CrossrefPubMedGoogle Scholar
  • 11 Newman M F, Kramer D, Croughwell N D. Differential age effects of mean arterial pressure and rewarming on cognitive dysfunction after cardiac surgery.  Anesth Analg. 1995;  81 236-242
    PubMedGoogle Scholar
  • 12 Tuman K J, McCarthy R J, Najafi H, Ivankovich A D. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations.  J Thorac Cardiovasc Surg. 1992;  104 1510-1517
    PubMedGoogle Scholar
  • 13 Newman M F, Croughwell N D, Blumenthal J A. Predictors of cognitive decline after cardiac surgery.  Ann Thorac Surg. 1995;  59 1326-1330
    CrossrefPubMedGoogle Scholar
  • 14 Lee W H, Brady M P, Rowe J M, Miller W C. Effects of extracorporeal circulation upon behaviour, personality, and brain function: Part II, hemodynamic, metabolic and psychometric correlations.  Ann Surg. 1971;  173 1013-1023
    PubMedGoogle Scholar
  • 15 Hammon J W, Stump D A, Butterworth J B, Moody D M. Approaches to reduce neurologic complications during cardiac surgery.  Semin Thorac Cardiovasc Surg. 2001;  13 184-191
    CrossrefPubMedGoogle Scholar
  • 16 Bucerius J, Gummert J F, Borger M A, Walther T, Doll N, Onnasch J F, Metz S, Falk V, Mohr F W. Stroke after cardiac surgery: A risk factor analysis of 16 184 consecutive patients.  Ann Thorac Surg. 2003;  75 472-478
    CrossrefPubMedGoogle Scholar
  • 17 Hill A B, Obrand D, O'Rourke K, Steinmetz O K, Miller N. Hemispheric stroke following cardiac surgery: A case control estimate of the risk resulting from ipsilateral asymptomatic carotid stenosis.  Ann Vasc Surg. 2000;  14 200-209
    CrossrefPubMedGoogle Scholar
  • 18 Katz E S, Tunick P A, Rusinek H, Ribakove G, Spencer F C, Kronzon K. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: Experience with intraoperative transesophageal echocardiography.  J Am Coll Cardiol. 1992;  104 70-77
    PubMedGoogle Scholar
  • 19 John R, Choudhri A F, Weinberg A D, Ting W, Rose E A, Smith C R, Oz M C. Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting.  Ann Thorac Surg. 2000;  69 30-35
    CrossrefPubMedGoogle Scholar
  • 20 Rolfson D B, McElhaney J E, Rockwood K, Finnegan B A, Entwistle L M, Wong J F, Suarez-Almazor M E. Incidence and risk factors for delirium and other adverse outcomes in older patients after coronary bypass graft surgery.  Can J Cardiol. 1999;  15 771-776
    PubMedGoogle Scholar

1 The results of this paper were presented in part during the 4th joint meeting of the Austrian, Swiss and German Society of Thoracic and Cardiovascular Surgery in Hamburg, Germany, February 15 - 18, 2004

Dr. Jens Litmathe

Department of Thoracic and Cardiovascular Surgery
Heinrich-Heine-University Düsseldorf

Moorenstraße 5

40225 Düsseldorf

Germany

Phone: + 492118118331

Fax: + 49 21 18 11 83 33

Email: litmathe@med.uni-duesseldorf.de

      >