Cardiovascular intervention: neurologic complications

Sara E Hocker MD (Dr. Hocker of the Mayo Clinic has no relevant financial relationships to disclose.)
Jose Biller MD (Dr. Biller of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (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.)
Originally released December 18, 2007; last updated August 3, 2016; expires August 3, 2019

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.

Overview

The number of persons undergoing cardiovascular intervention continues to increase. In fact, coronary artery bypass grafting is the most common surgical procedure performed in the United States. Cardiac procedures are being performed on an increasingly aged population, often with significant comorbidities. Thus, 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, a comprehensive review of central and peripheral nervous system complications of cardiac procedures is undertaken by the authors. 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, and issues pertaining to pregnancy. Neurologic complications of extracorporeal membrane oxygenation are included in this update.

Historical note and terminology

There have been dramatic technological advances in therapeutic interventions in the field of cardiology over the past 5 decades. Since the introduction of coronary artery bypass graft (CABG) surgery in the 1950s, the number of patients undergoing these and other cardiac procedures has continued to increase.

Although improvements in technology, as well as advances in surgical and anesthetic techniques, have reduced 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 in up to 6% (Gardner et al 1985; Redmond et al 1996; Roach et al 1996; Hogue et al 1999; Salazar et al 2001; Anyanwu et al 2007) and 1% (Goldstone et al 2011), respectively, are independent predictors of neurologic morbidity and mortality.

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.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.