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Cerebral complications of heart surgery 

Cerebral complications of heart surgery
Chapter:
Cerebral complications of heart surgery
Author(s):

Thomas H. Ottens

and Diederik van Dijk

DOI:
10.1093/med/9780199653478.003.0032
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date: 14 October 2019

Cerebral complications after heart surgery include stroke, postoperative cognitive decline (POCD), and delirium. Recently, the incidence of stroke after cardiac surgery has declined to about 2%. The risk differs across patient groups. POCD manifests with decreased memory and attention capacity and can be detected neuropsychologically. Elderly cardiac surgical patients have a high risk of postoperative delirium.The aetiology of cerebral complications of cardiac surgery is multifactorial. Cannulation and cross-clamping of the ascending aorta may cause embolic stroke. Cardiopulmonary bypass and direct recirculation of cardiotomy blood introduce microemboli. Low blood pressure during bypass increases the risk of stroke, but its role in pathogenesis is uncertain.Cerebral outcome can be improved by avoiding rapid rewarming and hyperthermia, and by tailoring MAP to patients’ specific requirements. Near-infrared spectroscopy may be useful. Surgeons may prevent stroke by using epiaortic ultrasound during aortic cannulation. Surprisingly, the randomized studies comparing surgery modalities found no cerebral benefit of avoiding cardiopulmonary bypass.

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