Stroke and encephalopathy after cardiac surgery: an update.
OBJECTIVE
As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery.


RESULTS
Patients with preexisting cerebrovascular disease are at increased risk for these untoward neurological outcomes, which are associated with longer lengths of hospital stay, higher costs, and greater mortality. The mechanisms underlying these neurological events may include microemboli and hypoperfusion during surgery, and postoperative atrial fibrillation. Predictive models, based on information available before surgery, allow identification of these "high risk" patients.


CONCLUSIONS
Establishing the degree of functionally significant vascular disease of the brain before surgery should be an essential part of the preoperative evaluation, particularly when modifications in surgical technique or novel neuroprotective agents are being evaluated.
McKhann
Guy M
GM
Department of Neurology, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA. guy.mckhann@jhu.edu
Grega
Maura A
MA
Borowicz
Louis M
LM
Baumgartner
William A
WA
Selnes
Ola A
OA
D000368:Aged; D001011:Aorta / Q000473:pathology; D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology; D006348:Cardiac Surgical Procedures; D002560:Cerebrovascular Circulation; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome