Intraoperative Neuromonitoring, Neuroprotection and Preventive Carotid Endarterectomy in Patients with Increased Risk for Development of Cerebral Ischemia Indicated for Cardiosurgery

Czech version

Authors: J. Mraček; I. Holečková; J. Mork; J. Frdlík ^*; J. Škorpil ^*
Authors‘ workplace: Neurochirurgické oddělení LF UK a FN Plzeň, primář: MUDr. M. Choc, CSc. ; Kardiochirurgické oddělení LF UK a FN Plzeň, primář: MUDr. T. Hájek ^*
Published in: Rozhl. Chir., 2009, roč. 88, č. 5, s. 264-268.
Category: Monothematic special - Original

Overview

Aim of study:
To demonstrate the benefit of peroperative electrophysiological monitoring and neuroprotection in cardiac surgery that makes use a cardiopulmonary bypass in patients with a high risk of stroke and to analyze the importance of prophylactic carotid endarterectomy.

Background:
Cerebral ischemia is the most dreaded complication of cardiovascular operations that make use of a cardiopulmonary bypass. It is necessary to select an approach that minimalizes neurological complications. In our treatment strategy we use preoperative electrophysiological monitoring and neuroprotection. Prophylactic carotid endarterectomy performed as part of a combined operation we performed in patients with a high risk of hemodynamic stroke.

Method:
We retrospectively evaluated 86 patients (2004–2008) after cardiac surgery that made use of a cardiopulmonary bypass and synchronous electrophysiological neuromonitoring. After any decrease in neuronal function neuroprotection was used. Combined carotid and cardiac operations were performed under one general anestesia in ten patients with a high risk of hemodynamic stroke.

Results:
A peroperative decline in electrophysiological responses was noted in 76.5%, of these 54.5% were insignificant alterations, 42.4% significant and in two cases there was a total deletion. After administration of neuroprotection electrophysiological responses partially normalized in 14%, totally normalized in 60% and did not change in 26%. Only one permanent stroke and four temporary encephalopathy were identified after surgery. No morbidity/mortality were detected after combined operations.

Conclusion:
Peroperative electrophysiological neuromonitoring combined with neuroprotection eliminate cerebral ischemic complications in cardiac surgery that makes use of a cardiopulmonary bypass. Selected patients with high risk of hemodynamic stroke profit from carotid endarterectomy.

Key words:
carotid artery stenosis – cardiac surgery – cardiopulmonary bypass – stroke – neuromonitoring – neuroprotection – carotid endarterectomy

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