Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions.
OBJECTIVE
Neurological complication remains a feared and increasing problem in association with cardiac surgery. The aim of this study was to analyze risk factors for neurological complications in a cohort of patients in whom inotropes for weaning from cardiopulmonary bypass was gradually replaced by metabolic treatment.


METHODS
The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or combined CABG+valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors.


RESULTS
The incidence of neurological injury was 1.8% in patients undergoing isolated CABG and 5.4% after combined CABG+valve procedures. After cross-validation multivariate analysis identified history of cerebrovascular disease, advanced age and aortic cross-clamp time as independent risk factors for postoperative cerebral complications. Chronic obstructive pulmonary disease and number of bypasses also emerged as risk factors in the primary analysis.


CONCLUSIONS
In general, markers for advanced atherosclerosis, with history of cerebrovascular disease as the most important, emerged as predictors for neurological injury. Although it did not enter the final risk model, the results also suggest that postoperative heart failure deserves further surveillance as a potential risk factor for neurological complications. However, no evidence for untoward neurological effects associated with glutamate or glucose-insulin-potassium treatment was found.
Svedjeholm
R
R
Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Linköping, Sweden. rolf.svedjeholm@lio.se
Håkanson
E
E
Szabó
Z
Z
Vánky
F
F
D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery*; D011188:Potassium / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium