Departments of1Neurosurgery and.
2Cardiovascular Surgery, Iwate Medical University, Yahaba, Iwate; and.
J Neurosurg. 2023 Feb 10;139(3):741-747. doi: 10.3171/2023.1.JNS222059. Print 2023 Sep 1.
Subdural hemorrhage (SDH) has been reported to be the most frequent intracranial hemorrhagic complication following open heart surgery; however, its clinical features and pathophysiology remain unclear. The aim of this retrospective study was to elucidate the incidence, clinical course, and factors associated with the development of symptomatic SDH following heart valve surgery.
A retrospective review of medical records on the development of symptomatic SDH after heart valve surgery involving cardiopulmonary bypass (CPB) from April 2011 to March 2016 was performed. Patients who had undergone preoperative cranial computed tomography (CT) or brain magnetic resonance imaging (MRI) were included in this study, and factors associated with SDH following heart valve surgery were analyzed. When neurological symptoms developed after heart valve surgery, cranial CT or brain MRI was performed.
A total of 556 patients who had undergone heart valve surgery were analyzed. Among these patients, symptomatic SDH occurred in 11 (2.0%). The mean duration of symptomatic onset was 10.1 days (range 2-37 days). Ten of 11 patients (90.9%) developed SDH in the posterior fossa or occipital convexity. Logistic regression analysis revealed longer aortic clamp time (95% CI 1.00-1.10, p = 0.04), higher dose of heparin after surgery (95% CI 1.00-1.02, p = 0.001), and higher pulmonary artery pressure (PAP) just before disconnection of the CPB (95% CI 1.01-1.37, p = 0.04) as significantly associated with the development of SDH.
The incidence of symptomatic SDH following heart valve surgery was 2.0%. Symptoms due to SDH usually developed a few days to 1 month after surgery. Surprisingly, most SDHs developed in the posterior fossa or occipital convexity following heart valve surgery. A longer aortic clamp time, higher dose of heparin after surgery, and higher PAP just before disconnection of the CPB were related to the development of symptomatic SDH following heart valve surgery.
硬脑膜下血肿（SDH）是体外循环（CPB）心脏手术后最常见的颅内出血并发症，但SDH 的临床特征和病理生理学仍不清楚。本回顾性研究旨在阐明心脏瓣膜手术后出现症状性 SDH 的发生率、临床病程和相关因素。
对 2011 年 4 月至 2016 年 3 月行 CPB 心脏瓣膜手术后发生症状性 SDH 的病历进行回顾性分析。本研究纳入了术前进行过头颅计算机断层扫描（CT）或脑磁共振成像（MRI）的患者，并分析了心脏瓣膜手术后 SDH 的相关因素。当心脏瓣膜手术后出现神经系统症状时，行头颅 CT 或脑 MRI 检查。
共分析了 556 例行心脏瓣膜手术的患者。其中，11 例（2.0%）发生症状性 SDH。症状性发病的平均时间为 10.1 天（范围 2-37 天）。11 例患者中 10 例（90.9%）在后颅窝或枕骨凸面出现 SDH。Logistic 回归分析显示，主动脉夹闭时间较长（95%CI 1.00-1.10，p=0.04）、术后肝素剂量较高（95%CI 1.00-1.02，p=0.001）和 CPB 断开前肺动脉压（PAP）较高（95%CI 1.01-1.37，p=0.04）与 SDH 的发生显著相关。
心脏瓣膜手术后症状性 SDH 的发生率为 2.0%。SDH 引起的症状通常在手术后数天至 1 个月后出现。令人惊讶的是，大多数 SDH 发生在心脏瓣膜手术后的后颅窝或枕骨凸面。主动脉夹闭时间较长、术后肝素剂量较高和 CPB 断开前 PAP 较高与心脏瓣膜手术后症状性 SDH 的发生有关。
