Cerebrovascular Events After Cardiovascular Procedures

Abstract

Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been developed to substantially reduce the incidence of stroke after traditional cardiovascular procedures such as coronary artery bypass grafting, isolated valve surgery, and carotid endarterectomy. Subsequently, with the advent of minimally invasive technologies including percutaneous coronary intervention, carotid artery stenting, and transcatheter valve therapies, operators were faced with a new host of procedural risk factors, and efforts again turned toward identifying novel ways to reduce the risk of stroke. Fortunately, by understanding the procedural factors unique to these new techniques and applying many of the lessons learned from prior experiences, we are seeing significant improvements in the safety of these new technologies. In this review, the authors: 1) carefully analyze data from different cardiac procedural experiences ranging from traditional open heart surgery to percutaneous coronary intervention and transcatheter valve therapies; 2) explore the unique risk factors for stroke in each of these areas; and 3) describe how these risks can be mitigated with improved patient selection, adjuvant pharmacotherapy, procedural improvements, and novel technological advancements.

The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

“…Cardiovascular surgery is widely applied for the treatment of cardiovascular disease (1). Postcardiovascular surgical (PCS) patients have been observed to have unfavorable prognoses and multiple complications such as stroke (2) and acute respiratory distress syndrome (3) resulting from invasive cardiovascular procedures. Another frequently occurred complication, acute kidney injury (AKI), is also associated with increased mortality and morbidity (4) among PCS patients.…”

Komplikasi Multi Organ pada Pasien yang Menjalani Operasi Double Valve Replacement

“…3 Struk setelah bedah jantung terbuka seringkali muncul pada masa awal perioperatif. 12 Mekanisme struk setelah operasi penggantian katup jantung seringkali berhubungan dengan adanya emboli udara karena de-airing yang tidak adekuat setelah penggantian katup. [8][9][10][11][12] Penyebab lain struk setelah bedah jantung terbuka meliputi hipoperfusi serebral, ateroemboli, alterasi sawar darah-otak karena aktivasi kaskade koagulasi 12 Kerusakan neuron seringkali dieksaserbasi oleh proses inflamasi akibat CPB dan iskemia-reperfusi.…”

“…12 Mekanisme struk setelah operasi penggantian katup jantung seringkali berhubungan dengan adanya emboli udara karena de-airing yang tidak adekuat setelah penggantian katup. [8][9][10][11][12] Penyebab lain struk setelah bedah jantung terbuka meliputi hipoperfusi serebral, ateroemboli, alterasi sawar darah-otak karena aktivasi kaskade koagulasi 12 Kerusakan neuron seringkali dieksaserbasi oleh proses inflamasi akibat CPB dan iskemia-reperfusi. 13 Struk pascaoperasi jantung terbuka berhubungan dengan peningkatan mortalitas dan morbiditas pascaoperasi, terutama kebutuhan rehabilitasi pascaoperasi.…”

“…14 Saat ini, terdapat berbagai teknik operasi yang dapat dilakukan untuk mengurangi keberadaan emboli udara seperti pemberian gas karbon dioksida di area operasi dan penempatan suction ventrikel kiri. 12 Terapi tambahan seperti aspirin, statin dan aprotinin sebelum operasi dapat mengurangi risiko serebrovaskular perioperatif setelah bedah jantung terbuka. [8][9][10][11][12] Deteksi dini kejadian serebrovaskular sangatlah penting dalam manajemen pascaoperasi jantung.…”

“…12 Terapi tambahan seperti aspirin, statin dan aprotinin sebelum operasi dapat mengurangi risiko serebrovaskular perioperatif setelah bedah jantung terbuka. [8][9][10][11][12] Deteksi dini kejadian serebrovaskular sangatlah penting dalam manajemen pascaoperasi jantung. Berdasarkan rekomendasi ASA, Pencitraan CT atau MRI segera diindikasikan untuk membedakan struk iskemik atau hemoragik (Kelas I).…”