Skip to main content

Neurologic Complications After Cardiac Surgery: Stroke, Delirium, Postoperative Cognitive Dysfunction, and Peripheral Neuropathy

  • Chapter
  • First Online:
Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery
  • 1534 Accesses

Abstract

Neurologic complications including delirium, acute confusion, and stroke remain one of the most feared complications after cardiac surgery, and are associated with longer hospital stays, a higher risk of discharge to long-term care facilities, and higher risk of multiple morbidities and death during the index hospital stay and after discharge. This chapter will discuss neurologic complications in the post-cardiac surgical population across the following categories: Stroke, Delirium and other Neuropsychiatric Encephalopathies, Peripheral Neuropathies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Selnes OA, Gottesman RF, Grega MA, et al. Cognitive and neurologic outcomes after coronary-artery bypass surgery. N Engl J Med. 2012;366:250–7.

    Article  CAS  Google Scholar 

  2. Messe SR, Acker MA, Se K, et al. Stroke after aortic valve surgery: results from a prospective cohort. Circulation. 2014;129:2253–61.

    Article  Google Scholar 

  3. Gaudino M, Rahouma M, Di Muro M, Yanagawa B, Abouarab A, Demetres M, et al. Early versus delayed stroke after cardiac surgery: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8:e012447.

    Google Scholar 

  4. McDonagh DL, Berger M, Mathew JP, Graffagnino C, Milano CA, Newman MF. Neurological complications of cardiac surgery. Lancet Neurol. 2014;13:490–502.

    Article  Google Scholar 

  5. Tarakji KG, Sabik JF, Bhudia SK, Batizy LH, Blackstone EH. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011;305(4):381–90.

    Article  CAS  Google Scholar 

  6. Hogue CW Jr, Murphy SF, Schechtman KB, Dávila-Román VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100(6):642–7.

    Article  Google Scholar 

  7. Patel N, Minhas JS, Chung EM. Risk factors associated with cognitive decline after cardiac surgery: a systematic review. Cardiovasc Psychiatry Neurol. 2015;12:370612. https://doi.org/10.1155/2015/370612.

    Article  Google Scholar 

  8. Hu WS, Lin CL. Postoperative ischemic stroke and death prediction with CHA(2)DS(2)-VASc score in patients having coronary artery bypass grafting surgery: a nationwide cohort study. Int J Cardiol. 2017;241:120–3.

    Article  Google Scholar 

  9. McKhann GM, Grega MA, Borowicz LM Jr, et al. Stroke and encephalopathy after cardiac surgery: an update. Stroke. 2006;37:562–71.

    Article  Google Scholar 

  10. Sun LY, Chung AM, Farkouh ME, et al. Defining an intraoperative hypotension threshold in association with stroke in cardiac surgery. Anesthesiology. 2018;129:440–7.

    Article  Google Scholar 

  11. Gold JP, Charlson ME, Williams-Russo P, Szatrowski TP, Peterson JC, Pirraglia PA, Hartman GS, Yao FS, Hollenberg JP, Barbut D, Hayes JG, Thomas SJ, Purcell MH, Mattis S, Gorkin L, Post M, Krieger KH, Isom OW. Improvement of outcomes after coronary artery bypass: a randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg. 1995;110:1302–11. discussion 1311-4

    Article  CAS  Google Scholar 

  12. Abu-Omar Y, Balacumaraswami L, Pigott DW, Matthews PM, Taggart DP. Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures. J Thorac Cardiovasc Surg. 2004;127(6):1759–65.

    Article  Google Scholar 

  13. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(24):e123–210.

    Article  Google Scholar 

  14. Siemieniuk RAC, Chu DK, Kim LH, Güell-Rous MR, Alhazzani W, Soccal PM, Karanicolas PJ, Farhoumand PD, Siemieniuk JLK, Satia I, Irusen EM, Refaat MM, Mikita JS, Smith M, Cohen DN, Vandvik PO, Agoritsas T, Lytvyn L, Guyatt GH. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. https://doi.org/10.1136/bmj.k4169.

    Article  Google Scholar 

  15. Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, Cherubini A, Jones C, Kehlet H, MacLullich A, Radtke F, Riese F, Slooter AJ, Veyckemans F, Kramer S, Neuner B, Weiss B, Spies CD. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017;34(4):192–214. https://doi.org/10.1097/EJA.0000000000000594.

    Article  Google Scholar 

  16. Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, Keage HAD. Cognitive outcomes following coronary artery bypass grafting: a systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019;289:43–9.

    Article  Google Scholar 

  17. Vlisides P, Avidan M. Recent advances in preventing and managing postoperative delirium. F1000 Res. 2019;8(F1000 Facult Rev):607. Last updated May 2019.

    Google Scholar 

  18. Berger M, Terrando N, Smith SK, Browndyke JN, Newman MF, Mathew JP. Neurocognitive function after cardiac surgery: from phenotypes to mechanisms. Anesthesiology. 2018;129:829–51.

    Article  Google Scholar 

  19. Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, Gan TJ, McEvoy MD, Miller TE, for the Perioperative Quality Initiative (POQI) 6 Workgroup. American Society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analog. 2020.

    Google Scholar 

  20. Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, Jones RN. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30–9. https://doi.org/10.1056/NEJMoa1112923.

    Article  CAS  Google Scholar 

  21. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK. The Richmond agitation–sedation scale. Am J Respir Crit Care Med. 2002;166(10):1338–44. https://doi.org/10.1164/rccm.2107138.

    Article  Google Scholar 

  22. American Geriatrics Society. Beers criteria update expert panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use. J Am Geriatr Soc. 2015;63(11):2227–46.

    Article  Google Scholar 

  23. Chan MRV, Hedrick TL, Egan TD, Garcia PS, Koch S, Purdon P, Ramsay MA, Miller TE, McEvoy MD, Gan TJ, on behalf of the Perioperative Quality Initiative POQI) 6 Workgroup. American Society for enhanced recovery and perioperative quality initiative joint consensus statement on the role of neuromonitoring in perioperative outcomes: electroencephalography. Anesth Analg. 2019. https://doi.org/10.1213/ANE.0000000000004502

  24. Duan X, Coburn M, Rossant R, Sanders RD, Waesberghe JV, Kowark A. Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomized controlled trials. Br J Anaesth. 2018;121:384–97.

    Article  CAS  Google Scholar 

  25. Cui Y, et al. The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia a network meta-analysis. J Clin Anesth. 2019;59:89–98.

    Article  Google Scholar 

  26. Miller D, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev. 2019;8:CD012317.

    Google Scholar 

  27. Burry L, Hutton B, Williamson DR, Mehta S, Adhikari NK, Cheng W, Ely EW, Egerod I, Fergusson DA, Rose L. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev. 2019;9:CD011749.

    Google Scholar 

  28. Leigh V, Stern C, Elliott R, Tufanaru C. Effectiveness and harms of pharmacological interventions for the treatment of delirium in adults in intensive care units after cardiac surgery: a systematic review. JBI Database System Rev Implement Rep. 2019. https://doi.org/10.11124/JBISRIR-D-18-00010.

  29. Lu Y, Li YW, Want L, Lydic R, Baghdoyan HA, Shi XY, Zhang H. Promoting sleep and circadian health may prevent postoperative delirium: a systematic review and meta-analysis of randomized clinical trials. Sleep Med Rev. 2019;48:101207.

    Article  Google Scholar 

  30. Lewis SR, et al. Melatonin for the promotion of sleep in adults in the intensive care unit. Cochrane Database Syst Rev. 2019;5:CD012455.

    Google Scholar 

  31. Hu RF, et al. Non-pharmacologic interventions for sleep promotion in the intensive care unit. Cochrane Database Syst Rev. 2015;10:CD008808.

    Google Scholar 

  32. Kim DH, Kim CA, Placide S, Lipsitz LA, Marcantonio ER. Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review. Ann Intern Med. 2016;65:650–60.

    Article  Google Scholar 

  33. Pataraia E, Jung R, Aull-Watschinger S, Skhirtladze-Dworschak K, Dworschak M. J Cardiothorac Vasc Anesth. 2018;32:2323–9.

    Article  Google Scholar 

  34. Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA. Tranexamic acid-associated seizures: causes and treatment. Ann Neurol. 2016;79(1):18–26.

    Article  CAS  Google Scholar 

  35. McKhann GM, Grega MA, Borowicz LM Jr, Bailey MM, Barry SJ, Zeger SL, Baumgartner WA, Selnes OA. Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. Neurology. 2005;65(7):991–9.

    Article  CAS  Google Scholar 

  36. Clark RE, Brillman J, Davis DA, Lovell MR, Price TR, Magovern GJ. Microemboli during coronary artery bypass grafting. Genesis and effect on outcome. J Thorac Cardiovasc Surg. 1995;109(2):249.

    Article  CAS  Google Scholar 

  37. Hogan AM, Shipolini A, Brown MM, Hurley R, Cormack F. Fixing hearts and protecting minds: a review of the multiple, interacting factors influencing cognitive function after coronary artery bypass graft surgery. Circulation. 2013;128(2):162–71.

    Article  Google Scholar 

  38. Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke. 1987;18(4):700–7.

    Article  CAS  Google Scholar 

  39. Eggermont LH, de Boer K, Muller M, et al. Cardiac disease and cognitive impairment: a systematic review. Heart. 2012;98:1334–40.

    Article  Google Scholar 

  40. UptoDate. Neurologic complications of cardiac surgery. Available at www.uptodate.com.

  41. Welch MB, Brummett CM, Welch TD, et al. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology. 2009;111:490–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Janet Martin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martin, J., Cheng, D.C.H. (2021). Neurologic Complications After Cardiac Surgery: Stroke, Delirium, Postoperative Cognitive Dysfunction, and Peripheral Neuropathy. In: Cheng, D.C., Martin, J., David, T. (eds) Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-47887-2_55

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47887-2_55

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47886-5

  • Online ISBN: 978-3-030-47887-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics