Patel Nikil, Minhas Jatinder S, Chung Emma M L
University of Leicester, Leicester, UK
University of Leicester, Leicester, UK.
Semin Cardiothorac Vasc Anesth. 2016 Sep;20(3):225-31. doi: 10.1177/1089253215626728. Epub 2016 Jan 18.
Since the advent of cardiac surgery, complications have existed in many forms. Recent work has focused on the safety of current cardiac surgery with particular emphasis on cognitive outcomes. Cardiopulmonary bypass has improved the safety of operative practice; however, increasing concern surrounds the measurable and immeasurable impact embolization has on the brain. New ischemic lesions have been associated with distant emboli, which intraoperatively enter the cardiovascular system. This has prompted better characterization of the nature of emboli manifesting as cognitive impairment postoperatively. The difficulty in attributing causation relates to the subclinical damage that does not necessarily manifest as clinical stroke. Transcranial Doppler has become an important tool in documenting cerebral emboli during surgery. The purpose of this systematic review is to focus on the current literature to improve our understanding of the impact embolization has on the brain. We also aim to investigate which cardiac interventions hold the greatest burden of embolic load and how previous literature has investigated the impact of emboli on cognition by monitoring emboli during specific cardiac interventions. Significant intraoperative factors such as the cardiopulmonary bypass machine and surgical interventions have been highlighted to summarize the current literature associating cerebral embolization with these factors and postoperative cognitive outcomes. The findings of this review report that the current literature is divided as to whether the impact of embolization during cardiac surgery has any adverse impact on cognition. This review highlights that the ultimate goal of improving cognitive safety will involve further careful consideration of multifactorial events.
自心脏外科手术问世以来，并发症就以多种形式存在。近期的研究工作聚焦于当前心脏手术的安全性，尤其关注认知方面的结果。体外循环改善了手术操作的安全性；然而，越来越多的担忧围绕着栓塞对大脑产生的可测量和不可测量的影响。新的缺血性病变与术中进入心血管系统的远处栓子有关。这促使人们更好地描述术后表现为认知障碍的栓子的性质。确定因果关系的困难在于亚临床损伤不一定表现为临床中风。经颅多普勒已成为手术期间记录脑栓塞的重要工具。本系统综述的目的是聚焦当前文献，以增进我们对栓塞对大脑影响的理解。我们还旨在调查哪些心脏干预措施的栓塞负荷负担最重，以及以往文献是如何通过在特定心脏干预期间监测栓子来研究栓子对认知的影响的。已强调了体外循环机和手术干预等术中重要因素，以总结当前将脑栓塞与这些因素及术后认知结果相关联的文献。本综述的结果表明，当前文献对于心脏手术期间栓塞的影响是否对认知有任何不利影响存在分歧。本综述强调，提高认知安全性的最终目标将需要进一步仔细考虑多因素事件。
