Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · May 2002
Review[Neurologic events after heart surgery: the need for a more thorough preoperative assessment].
The occurrence of neurologic complications after cardiac surgery varies widely and has increased during the last years for several reasons: older age of patients, higher prevalence aortic valve replacement, and more careful diagnosis of cerebral ischemia. Recent studies showed that embolic mechanism is involved in most patients, and two main clinical outcomes are detectable: type I outcome, consisting of TIA and ischemic stroke, and type II outcome, consisting of cognitive defects and seizures. ⋯ The preoperative work-up should include two-dimensional echocardiography, transesophageal echocardiography (for detecting patients with ascending aortic lesion who need alternative surgical strategies, i.e. different site of cross clamping, cannulation, and proximal anastomosis of the venous graft), Doppler ultrasound of carotid arteries (for identifying those candidates to combined surgery), and psychobehavioural evaluation (for selecting patients with cognitive deterioration who could be treat by off-pump surgery). In conclusion, a preoperative stratification of the neurologic risk, and a more careful postoperative monitoring should be mandatory for preventing and adequately treating neurologic complications of cardiac surgery.