Central nervous system protection in cardiac surgery

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Neurological dysfunction and stroke following cardiac surgery and thoracic surgery requiring hypothermic circulatory arrest is a well-defined problem. The original studies in CABG patients identified risk factors, such as prior stroke and lower educational level. There is older evidence suggesting that higher perfusion pressures during cardiopulmonary bypass are helpful. Hyperthermia during rewarming on cardiopulmonary bypass and postoperative hyperthermia have been associated with adverse cognitive outcomes. Glucose management intraoperatively remains controversial, but most now advocate for moderate glucose control using insulin, if required. The subset of patients having thoracic aortic surgery requiring periods of aortic discontinuity are particularly problematic. A cerebral protection strategy should be determined, and this may include hypothermic circulatory arrest, selective cerebral perfusion, or retrograde cerebral perfusion. All of these techniques have been associated with good surgical outcomes, but there is little information on cognitive outcomes of thoracic aortic surgery.

Original languageEnglish
Pages (from-to)32-37
Number of pages6
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume14
Issue number1
DOIs
StatePublished - Mar 2010

Keywords

  • Cardiac surgery
  • Cognitive outcomes
  • Hypothermic circulatory arrest
  • Neuropsychological outcomes
  • Selective cerebral perfusion
  • Thoracic aortic surgery

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