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Neurologic complications of cardiac surgery

Authors
Michael L McGarvey, MD
Albert T Cheung, MD
Mark M Stecker, MD, PhD
Section Editors
Michael J Aminoff, MD, DSc
Gabriel S Aldea, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Neurologic complications are second only to heart failure as a cause of morbidity and mortality following cardiac surgery, and the presence of neurologic sequelae significantly increases the likelihood of requiring long-term care [1-4].

The neurologic complications of cardiac surgery in adults will be reviewed here. Methods to prevent these complications, issues related to coronary artery bypass grafting (CABG) in patients with known carotid artery disease, and an overview of all early complications following CABG and are discussed separately. (See "Prevention of neurologic complications of cardiac surgery" and "Coronary artery bypass grafting in patients with cerebrovascular disease" and "Early noncardiac complications of coronary artery bypass graft surgery".)

INCIDENCE

Most neurologic problems following cardiac surgery can be divided into three categories (table 1) [2,5]:

  • Stroke
  • Neuropsychiatric abnormalities or encephalopathy
  • Peripheral neuropathies

A retrospective report from the Society of Thoracic Surgery (STS) National Cardiac Database, of over 400,000 cardiac surgeries between 1996 and 1997, reported an overall incidence of a new neurologic event (stroke, transient ischemic attack, or unexplained coma lasting more than 24 hours) of 3.3 percent [6]. A prospective study evaluated 2108 patients undergoing coronary artery bypass graft surgery (CABG) at 24 hospitals in the United States between 1991 and 1993 [2]. Overall, 6.1 percent suffered a cerebral complication, roughly equally divided between stroke and encephalopathy. Increased age was a dominant risk factor, and adverse events were associated with increased mortality, longer hospitalization, and a higher rate of discharge to chronic care facilities compared with those without neurologic sequelae (figure 1).

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 02 00:00:00 GMT+00:00 2013.
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