[Cerebral complication during open heart surgery in relation to cerebral arterial stenosis documented by angiography].
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).
Department of Cardiovascular Surgery, Kumamoto Chu-oh Hospital.
T
T
Uezu
R
R
Sakata
K
K
Ueyama
Y
Y
Umebayashi
T
T
Ueno
M
M
Ura
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D003251:Constriction, Pathologic; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery