LONG-TERM NEUROLOGIC OUTCOME AFTER CARDIAC OPERATION

Cardiac surgical patients face the threat of neurologic complications in all phases of their disease and its treatment. The incidence of pre operative transient ischemic attacks and stroke ranges from 5% to 14% and from 2% to 11%, respectively. The risk of preoperative cerebrovasc ular accidents is higher in patients with valvular disease than in tho se with coronary artery disease. The prevalence of postoperative neuro logic disorders varies widely because of differences in defining the c linical criteria, heterogeneity of patient populations, timing of eval uation, follow-up times, study designs, and surgical and anesthesia-re lated procedures. Fatal cerebral damage is very rare (< 0.1%). Focal c erebral deficits, or definite stroke, are encountered in 1% to 3% of p atients and minor clinical abnormalities, in 5% to 10%. Recent studies have shown that contrary to previous concepts, valve replacement does not carry essentially higher neurologic risks than coronary bypass gr afting. The most common causes of operation-related neurologic disorde rs are microembolization or macroembolization and hypoperfusion. Altho ugh most disorders resolve early postoperatively, some deficits persis t. From the neurologic standpoint, a main objective of a cardiac surgi cal intervention is to prevent stroke. Today, the incidence of cardiog enic cerebrovascular accidents is very low after reparative cardiac pr ocedures. Despite surgical and anesthesia-related improvements, neurol ogic complications do occur. Multidimensional investigatory procedures have shown that cardiopulmonary bypass often causes cerebral dysfunct ion. Whether the harmful consequences are detected depends on the eval uation criteria and the investigatory methods and timing used. Further methods are needed to prevent or treat preoperative cerebrovascular a ccidents and particularly to improve cerebral protection during operat ive procedures.