Neuroprotection in Cardiac Surgery

Abstract

Several hundred thousand patients in the United States undergo cardiac surgery. The most common procedures include those for coronary artery disease, valvular heart disease, aortic disease, surgery for heart failure, congenital heart disease, transplantation, and a variety of other combined procedures. Neurologic injury is a significant risk factor for patients undergoing cardiac surgery. Although stroke, with an incidence of 1% to 6%, is the most serious complication, cognitive impairment (25% to 65%) and impaired level of consciousness (approximately 10%) can be significantly troublesome for patients and lead to potential further complications [1]. This latter complication can consist of encephalopathy, delirium, confusion, and depression. Atherosclerotic emboli from the aorta and great vessels and hypoperfusion to watershed regions of the brain are the predominant causes of stroke (or cerebrovascular accident). The cause of cognitive impairment and impaired level of consciousness is multifactorial and has been attributed to hypoperfusion, microemboli, metabolic derangements, general anesthesia, and initiation of a proinflammatory state.