Evaluation of Staged TCAR and Cardiac Surgery or Structural Heart Intervention

2021 ◽  
pp. 153857442110177
Author(s):  
Maxwell Almenoff ◽  
H. Edward Garrett
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Disease ◽  
Neurological Complications ◽  
Percutaneous Intervention ◽  
Reversed Flow ◽  
Cardiac Intervention ◽  
Cardiac Pathology ◽  
Risk Patients ◽  
Staged Approach ◽  
Optimal Treatment Strategy

Introduction: The optimal treatment strategy for patients with concomitant carotid and cardiac disease remains controversial. Transcarotid artery revascularization stenting with reversed flow protection (TCAR) has achieved results equivalent to carotid endarterectomy (CEA) in high risk patients. Methods: A retrospective review of all patients at a single center who received staged TCAR prior to cardiac intervention was performed. Results: 37 patients underwent 42 TCAR procedures prior to cardiac intervention (25 requiring open cardiac surgery and 12 requiring percutaneous intervention). There were no myocardial or neurological complications following TCAR prior to cardiac intervention. Three patients (8%) developed a neck hematoma which required evacuation. Conclusion: A staged approach to combined carotid and cardiac pathology with TCAR prior to cardiac intervention appears to be a safe and effective strategy.

scholarly journals Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Juliana R. Caldas ◽  
Ronney B. Panerai ◽  
Edson Bor-Seng-Shu ◽  
Graziela S. R. Ferreira ◽  
Ligia Camara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
High Risk ◽  
Cognitive Decline ◽  
Neurological Complications ◽  
Cerebral Hemodynamics ◽  
High Risk Patients ◽  
Intra Aortic Balloon Pump ◽  
Risk Patients ◽  
Autoregulation Index

Abstract Background The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the ‘Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery’ (IABCS) trial. Methods This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction ≤ 40% or EuroSCORE ≥ 6 received preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n = 34) and without IABP (n = 33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded. Results There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5 ± 1.9 vs. 5.7 ± 1.7; T2: 4.0 ± 1.9 vs. 4.1 ± 1.6; T3: 5.7 ± 2.0 vs. 5.7 ± 1.6, p = 0.97) or CBFV (T1: 57.3 ± 19.4 vs. 59.3 ± 11.8; T2: 74.0 ± 21.6 vs. 74.7 ± 17.5; T3: 71.1 ± 21.3 vs. 68.1 ± 15.1 cm/s; p = 0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p = 0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00). Conclusions The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registrationhttp://www.clinicaltrials.gov (NCT02143544).

scholarly journals One-day, sequential carotid artery stenting followed by cardiac surgery in patients with severe carotid and cardiac disease

2019 ◽  
Vol 24 (5) ◽  
pp. 431-438 ◽  
Author(s):  
Karolina Dzierwa ◽  
Jacek Piatek ◽  
Piotr Paluszek ◽  
Tadeusz Przewlocki ◽  
Lukasz Tekieli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Carotid Artery ◽  
Cardiac Disease ◽  
Carotid Artery Stenting ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Class Iii ◽  
Sequential Approach ◽  
Ica Stenosis

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69–3.19%). All CAS procedures were performed according to the ‘tailored’ algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.

scholarly journals Neurological Complications of Cardiac Procedures

2021 ◽  
Author(s):  
Courtney M. Hrdlicka ◽  
Jeffrey Wang ◽  
Magdy Selim
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Neurological Complications ◽  
Diagnostic Workup ◽  
Diagnosis And Management ◽  
Percutaneous Interventions ◽  
Cardiac Procedures ◽  
Appropriate Treatment ◽  
Periprocedural Stroke

AbstractNeurological complications after cardiac surgery and percutaneous cardiac interventions are not uncommon. These include periprocedural stroke, postoperative cognitive dysfunction after cardiac surgery, contrast-induced encephalopathy after percutaneous interventions, and seizures. In this article, we review the incidence, pathophysiology, diagnosis, and management of these complications. Improved understanding of these complications could lead to their prevention, faster detection, and facilitation of diagnostic workup and appropriate treatment.

Sign in / Sign up

Export Citation Format

Share Document