Neurologic Complications in Cardiac Surgery. Is it Predictable?

  • J. O. C. AulerJr.
Conference paper


Despite all the progress observed in cardiac surgery in the last decades that have had an influence on the overall decrease of morbid-mortality, neurologic adverse effects presently represent a very important subject. After five decades since the first described reports of cardiopulmonary bypass (CPB), an enormous amount of medical information has been published about this method and the possible adverse effects or complications. As we mentioned adverse cerebral outcome is one of the principal causes of the length of stay and cost of hospitalization after cardiac surgery [1]. The question, based on the available medical information is “Would neurologic undesirable effects be minimized or even predictable during cardiac surgery?” Our aim in this lecture is to review these points and in a didactic meaning focus on cardiac surgery with CPB as an incidence of the nervous system morbidity, its classification according to morbid neurologic outcomes, the risk and mechanisms of neurological injury associated with the surgical procedure and, finally, the intraoperative management that may interfere with reducing cerebral events.


Cardiopulmonary Bypass S100 Protein Cerebral Embolus Neurologic Morbidity Aortic Atherosclerosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tu JV, Mazer CD, Levinton C et al (1994) A predictive index for length of stay in the intensive care unit following cardiac surgery. Can Med Assoc J 151: 177–185Google Scholar
  2. 2.
    Mangano DT (1995) Cardiovascular morbidity and CABG surgery — a perspective: epidemiology, costs, and potential therapeutic solutions. J Cardiol Surg 10(Suppl):366–368CrossRefGoogle Scholar
  3. 3.
    Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long term postoperative cognitive dysfunction in the elderly. Lancet 351: 857–861PubMedCrossRefGoogle Scholar
  4. 4.
    Roach WG, Kanchuger M, Mangano MC et al (1996) Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 335: 1857–1863PubMedCrossRefGoogle Scholar
  5. 5.
    Wolman RL, Nussmeier NA, Aggarwal A et al (1999) Cerebral injury after cardiac surgery: identification of a group of extraordinary risk. Stroke 30: 514–522PubMedCrossRefGoogle Scholar
  6. 6.
    Taggart DP, Browne SM, Halligan PW, Wade DT (1999) Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations. J Thorac Cardiovasc Surg 118(3): 414–420PubMedCrossRefGoogle Scholar
  7. 7.
    David JC (2000) Neurologic effects. In: Gravllee PG, Davis FR, Kursz M, Utley RJ (eds) Cardiopulmonary bypass: principle and practice. 2th ed. Lippincott Williams&Wilkins, Philadelphia, pp 404–424Google Scholar
  8. 8.
    Klafta JM, Jacny JP, Yong CJ (1995) Neurological and psychiatric adverse effects of anaesthetics: epidemiology and treatment. Drug Safety 13: 281–295PubMedCrossRefGoogle Scholar
  9. 9.
    Williams-Russo P, Sharrock NE, Mattis S et al (1995) Cognitive effects after epidural vs general anesthesia in older adults. JAMA 274: 44–50PubMedCrossRefGoogle Scholar
  10. 10.
    Blauth CI, Cosgrove DM, Webb BW et al (1992) Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 103: 1104–1112PubMedGoogle Scholar
  11. 11.
    Blauth CI (1995) Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 59: 1300–1303PubMedCrossRefGoogle Scholar
  12. 12.
    van der Linden J, Casimir-Ahn H (1991) When do cerebral emboli appear during open heart operations? A transcranial Doppler study. Ann Thorac Surg 51: 237–241PubMedCrossRefGoogle Scholar
  13. 13.
    Katz ES, Tunick PA, Rusinek H (1992) Protruding aortic atheromas predict a stroke in elderly patients undergoing bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardioll: 104: 70–77CrossRefGoogle Scholar
  14. 14.
    Hill GE (1996) The inflammatory response to cardiopulmonary bypass. Int Anesthesiol Clin 34: 95–108PubMedCrossRefGoogle Scholar
  15. 15.
    Johnsson P (1996) Markers of cerebral ischemia after cardiac surgery. J Cardiothorac Vasc Anesth 10: 120–126PubMedCrossRefGoogle Scholar
  16. 16.
    Zimmer DB, Cornwall EH, Landar A (1995) The S100 protein family, history, function, and expression. Brain Res Bull 37: 417–429PubMedCrossRefGoogle Scholar
  17. 17.
    Jönsson H, Johnssn P, Ailing C et al (1998) Significance of serum S100 release after coronary artery bypass grafting. Ann Thorac Surg 65: 1639–1644PubMedCrossRefGoogle Scholar
  18. 18.
    Arrowsmith JE, Grocott HP, Reves JG (2000) Central nervous system complications of cardiac surgery. Br J Anesth 84: 378–393CrossRefGoogle Scholar
  19. 19.
    Martin TD, Craver JM, Gott JP et al (1994) Prospective, randomized trial of retrograde warm cardioplegia: myocardial benefit and neurologic threat. Ann Thorac Surg 57: 298–304PubMedCrossRefGoogle Scholar
  20. 20.
    Gold JP, Charlson ME, Williams-Russo P et al (1995) Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 110: 1302–1311PubMedCrossRefGoogle Scholar
  21. 21.
    Plochl W, Cook DJ (1999) Quantification and distribution of cerebral emboli during cardiopulmonary bypass in the swine. The impact of CO2. Anesthesiology 909: 183–190CrossRefGoogle Scholar
  22. 22.
    Wareing TH, Davila-Roman VG, Barzilai B et al (1992) Management of the severely atherosclerotic ascending aorta during cardiac operations. A strategy for detection and treatment. J Thorac Cardiovasc Surg 103: 453–462PubMedGoogle Scholar
  23. 23.
    Hartman GS, Yao FS, Bruefach MIII et al (1996) Severity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study. Anesth Analg 83: 701–708PubMedGoogle Scholar
  24. 24.
    Soulter MJ, Andrews PJ, Alston RP (1998) Propofol does not ameliorate cerebral venous oxyhemoglobin desaturation during hypothermic cardiopulmonary bypass. Anesth Analg 86: 926–931Google Scholar
  25. 25.
    Legault, Furberg CD, Waggenknecht LE et al (1996) Nimodipine neuroprotection in cardiac valve replacement: report of an early terminated trial. Stroke 27: 593–598PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • J. O. C. AulerJr.
    • 1
  1. 1.Department of AnaesthesiologyHeart Institute, FMUSP Clinical HospitalSão PauloBrazil

Personalised recommendations