Neuroprotection during cardiac surgery

Expert Review of Cardiovascular Therapy
Niamh ConlonG Burkhard Mackensen

Abstract

Cardiac surgery continues to be associated with significant adverse cerebral outcomes, ranging from stroke to cognitive decline. The underlying mechanism of the associated cerebral injury is incompletely understood but is believed to be primarily caused by cerebral embolism and hypoperfusion, exacerbated by ischemia/reperfusion injury. Extensive research has been undertaken in an attempt to minimize the incidence of perioperative cerebral injury, and both pharmacological and nonpharmacological strategies have been investigated. Although many agents demonstrated promise in preclinical studies, there is currently insufficient evidence from clinical trials to recommend the routine administration of any pharmacological agents for neuroprotection during cardiac surgery. The nonpharmacological strategies that can be recommended on the basis of evidence include transesophageal echocardiography and epiaortic ultrasound-guided assessment of the atheromatous ascending aorta with appropriate modification of cannulation, clamping or anastomotic technique and optimal temperature management. Large-scale randomized controlled trials are still required to address further the issues of optimal pH management, glycemic control, blood pressure man...Continue Reading

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Citations

Apr 5, 2014·The Journal of Thoracic and Cardiovascular Surgery·Jae-Kwang ShimG Burkhard Mackensen
Apr 16, 2013·The Journal of Thoracic and Cardiovascular Surgery·Michael L JamesG Chad Hughes
Jan 17, 2012·Journal of Cardiothoracic and Vascular Anesthesia·Larisa Zhurav, Troy S Wildes
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Jun 1, 2016·Interactive Cardiovascular and Thoracic Surgery·Stephanie GrabertSabine Bleiziffer
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May 6, 2020·Journal of Cardiac Surgery·Jesse CottrellHannah Copeland
May 19, 2010·Seminars in Cardiothoracic and Vascular Anesthesia·Kristine Kellermann, Bettina Jungwirth
Sep 16, 2016·Heart·I M van HagenJ W Roos-Hesselink
Jun 3, 2020·Journal of Cardiac Surgery·Chandni PatelAmer Harky
Apr 18, 2018·Journal of Cardiac Surgery·Robert J MoracaMichael S Halbreiner
Mar 6, 2019·Animal Cells and Systems·Yun-Hee KimJae-Hwan Kim

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