INTRAOPERATIVE AND POSTOPERATIVE CEREBRAL COMPLICATIONS OF OPEN-HEART-SURGERY

A consecutive series of 1400 patients who had undergone open-heart sur gery was retrospectively reviewed concerning postoperative cerebral dy sfunction. The 30-day mortality was 1.6%. Forty-one patients (2.9%) sh owed signs of cerebral dysfunction, which proved fatal in seven cases. Neurologic symptoms were observed immediately after surgery in 14 pat ients, suggesting intraoperative damage. In 20 others there was an int erval between surgery and the onset of cerebral symptoms, which in 12 cases were preceded by supraventricular tachycardia. Computed tomograp hic scans were performed on 27 patients and showed recent brain infarc tion in 22. No bleeding was found. At followup 34 of the 41 patients w ere alive, 21 of them with neurologic sequelae and 13 reporting comple te recovery. Nineteen of the 34 survivors experienced no diminution of quality of life. Since half of the cerebral complications occurred po stoperatively, more aggressive prevention and management of supraventr icular tachyarrhythmia and anticoagulation therapy should be considere d.