Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
This article includes discussion of cardiovascular intervention: neurologic complications and coronary artery bypass grafting. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Since the introduction of coronary artery bypass graft (CABG) surgery in the 1950s, the number of persons undergoing a cardiovascular procedure or intervention continues to increase. In fact, coronary artery bypass grafting is the most common surgical procedure performed in the United States. Because of this it is important to review not only the proper diagnosis of neurologic events, but also the strategies that are used to reduce the occurrence of these events. In this update, the authors undertake a comprehensive review of central and peripheral nervous system complications of cardiac procedures. This review addresses the neurologic complications of cardiovascular intervention, including coronary artery bypass grafting, aortic surgery, heart valve replacement, cardiac transplantation, ventricular assist device implantation, cardiac catheterization, percutaneous coronary interventions, electrophysiological studies, surgery for congenital heart disease, extracorporeal membrane oxygenation (ECMO), and issues pertaining to pregnancy.
Historical note and terminology
There have been dramatic technological advances in therapeutic interventions in the field of cardiology over the past several decades. As a result, the number of patients undergoing these and other cardiac procedures has continued to increase particularly to include the further aging population with significant comorbidities.
Through improvements in technology, along with advances in surgical and anesthetic techniques, there has been a reduction in mortality related to cardiovascular procedures; neurologic complications continue to be recognized as important factors in postoperative morbidity from these procedures. For example, the occurrence of strokes and seizures that complicate cardiac surgical procedures can be as high as 7% (Gardner et al 1985; Redmond et al 1996; Roach et al 1996; Hogue et al 1999; Salazar et al 2001; Anyanwu et al 2007; Gottesman et al 2008) and 1% (Goldstone et al 2011), respectively. Neurologic injury, such as stroke or seizure, is a strong independent predictor of neurologic morbidity and mortality as well as quality of life. The mortality rate can be increased almost 10 fold (Gottesman et al 2008).
This problem is important due to the fact that cardiac procedures are being performed on an increasingly aged population, often with significant comorbidities. Thus, it is important to discuss not only the proper diagnosis of neurologic events, but also the strategies that are used to reduce the occurrence of these events.
This review will address the neurologic complications of cardiac procedures including CABG, ventricular assist device implantation, aortic surgery, heart valve replacement, cardiac transplantation, cardiac catheterization, percutaneous coronary interventions, electrophysiological studies, surgery for congenital heart disease, and issues pertaining to pregnancy.
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