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  • Updated 07.20.2022
  • Released 12.18.2007
  • Expires For CME 07.20.2025

Cardiovascular intervention: neurologic complications

Introduction

Overview

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 associated neurologic complications, 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.

Key points

• Stroke complicates up to 5% of cardiac surgical procedures.

• Neurologic complications after cardiac procedures can affect any part of the central or peripheral nervous system

• Patients with acute stroke after a cardiac procedure may be eligible for acute stroke treatment including mechanical thrombectomy.

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 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. Strokes complicate 1% to 5% of cardiac surgical procedures (78; 173; 14; 88; 59) and seizures complicate 1% (83). Neurologic complication, such as stroke or seizure, is a strong independent predictor of neurologic morbidity and mortality, which can be increased almost tenfold (88).

Cardiac procedures are being performed on an increasingly aged population, often with significant medical comorbidities, such as aging, depression, mild cognitive, carotid artery stenosis, or heart failure that place them at higher risk for neurologic complication (43). 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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