Neurologic complications of open heart surgery

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Neurologic problems occurring in patients undergoing open heart surgery are infrequent, but nevertheless tangible. Problems have included prolonged “metabolic” encephalopathies, cerebrovas-cular infarcts, seizures, peroneal palsies, and brachial plexus injuries, to cite the main examples. Although there is a considerable literature concerning the neurologic findings associated with cardiac valve surgery and some data are available on the subject of the neurologic phenomenology associated with cardiac transplantation, there is virtually no information on the subject of neurologic difficulties encountered in the patient population undergoing coronary artery bypass graft procedures.1–6 With the large experience in open heart surgery at The Cleveland Clinic Foundation, it was decided to study prospectively a series of 531 patients who underwent various open heart procedures in an effort to identify the types of neurologic difficulties encountered, their frequency, and risk factors for neurologic compromise. The patients were studied by neurologists before and one or more times after open heart surgery. Four hundred fifty-one preoperative, operative, and postoperative variables were assessed. In the myocardial revascularization group, 380 patients underwent bypass grafting for the first time and 38 for the second time.

Beginning on the fourth postoperative day in the myocardial revascularization group, new central nervous system (CNS) deficits were found in 68 of 418 patients (16%). However, only nine patients (2%) experienced significant functional debilitation. Twenty-two of 68 (37%) of all CNS complications were focal, and in ten (45%) of these a possible cause was documented. All remaining CNS complications, 46 of 68 (68%), were nonfocal or diffuse . . .



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