[Neurologic events after heart surgery: the need for a more thorough preoperative assessment].
The occurrence of neurologic complications after cardiac surgery varies widely and has increased during the last years for several reasons: older age of patients, higher prevalence aortic valve replacement, and more careful diagnosis of cerebral ischemia. Recent studies showed that embolic mechanism is involved in most patients, and two main clinical outcomes are detectable: type I outcome, consisting of TIA and ischemic stroke, and type II outcome, consisting of cognitive defects and seizures. The overall prevalence of neurologic complications after cardiac surgery is nearly 16% and suggests the need of systematic preoperative evaluation of patients for identifying those with high risk and the individualization of the surgical strategy. The preoperative work-up should include two-dimensional echocardiography, transesophageal echocardiography (for detecting patients with ascending aortic lesion who need alternative surgical strategies, i.e. different site of cross clamping, cannulation, and proximal anastomosis of the venous graft), Doppler ultrasound of carotid arteries (for identifying those candidates to combined surgery), and psychobehavioural evaluation (for selecting patients with cognitive deterioration who could be treat by off-pump surgery). In conclusion, a preoperative stratification of the neurologic risk, and a more careful postoperative monitoring should be mandatory for preventing and adequately treating neurologic complications of cardiac surgery.
Urbinati
S
S
Unità Operativa di Cardiologia, Ospedale Bellaria, Bologna.
Poci
M G
MG
Pinelli
G
G
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors
Eventi neurologici post-cardiochirurgia: la necessità di una valutazione pre-operatoria più approfondita.