Neurological Complications in Patients Undergoing Cardiac Surgery: A Tertiary Care Experience

Authors

DOI:

https://doi.org/10.53350/pjmhs020251912.4

Keywords:

Cardiac surgery; Delirium; Stroke; Cerebral oxygenation, Double valve replacement (DVR).

Abstract

Background: Morbidity related to neurology complications continues to be a major issue after cardiac surgery. Postoperative stroke and delirium contribute to prolonged hospital ICU stay and increase in cost as well.

Methods: Prospective observational study conducted at Mayo Hospital Lahore in Cardiac surgery Department from July 2024 to June 2025. A total of 210 adult patients undergoing cardiac surgery participated in the research. Demographic factors, comorbidity, variables of surgery and neurological outcomes were examined. The patterns of occurrence of the neurological complications by the type of procedure and high-risk groups were assessed. Predictors of postoperative neurological complications were identified by using multi-variable analysis.

Results: The risk of neurological complications depended on the complexity of the procedures performed with high incidence of strokes being reported in Mitral and Aortic valvular surgeries and in both CABG + valvular surgeries in comparison to isolated Coronary Artery Bypass Grafting CABG. Postoperative delirium was strongly predictable by advanced age, high scores in surgical risk, previous cerebrovascular pathology, and a decrease in cerebral oxygen saturation.

Conclusion: Multi-factorial neurological complications after Cardiac Surgery procedures are dependent and affected by patient factors, the complexity of procedures and  physiological events. Early risk factors evaluation and perioperative management in cardiac surgery should be optimised  to enhance the neurological outcome.

References

Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021.

Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818-827

Gorton AJ, Saha SP. The History of Coronary Artery Disease. Int J Angiol. 2025 Jun 27;34(4):243-252. doi: 10.1055/a-2624-5607. PMID: 41210677; PMCID: PMC12591718.

Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac Surgery in Low- and Middle-Income Countries: A State-of-the-Art Review. Ann Thorac Surg. 2021 Apr;111(4):1394-1400. doi: 10.1016/j.athoracsur.2020.05.181. Epub 2020 Aug 6. PMID: 32771467.

Cote CL, De Waard D, Tansley G, Horne G, Hassan A, Hajizadeh M, Herman CR. Increased travel time to the tertiary centre is associated with decreased long-term survival following ascending aortic operations. Canadian Journal of Cardiology. 2022 Jun 1;38(6):801-7.

Teller J, Gabriel MM, Schimmelpfennig SD, Laser H, Lichtinghagen R, Schäfer A, Fegbeutel C, Weissenborn K, Jung C, Hinken L, Worthmann H. Stroke, seizures, hallucinations and postoperative delirium as neurological complications after cardiac surgery and percutaneous valve replacement. Journal of cardiovascular development and disease. 2022 Oct 24;9(11):365.

Tian LJ, Yuan S, Zhou CH, Yan FX. The effect of intraoperative cerebral oximetry monitoring on postoperative cognitive dysfunction and ICU stay in adult patients undergoing cardiac surgery: an updated systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022 Feb 1;8:814313.

Suraarunsumrit P, Pathonsmith C, Srinonprasert V, Sangarunakul N, Jiraphorncharas C, Siriussawakul A. Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country. BMC geriatrics. 2022 Mar 16;22(1):213.

Munteanu C, Onose G, Turnea MA, Rotariu M. Cellular and Molecular Homeostatic Micro-environmental im-balances in Osteo-arthritis and Rheumatoid Arthritis. Balneo and PRM Research Journal 2023, 14 (2). 2023 Jun 1;564.

Swat SA, Helmkamp LJ, Tietbohl C, Thompson JS, Fitzgerald M, McIlvennan CK, Harger G, Ho PM, Ahmad FS, Ahmad T, Buttrick P, Allen LA. Clinical Inertia Among Outpatients With Heart Failure: Application of Treatment Nonintensification Taxonomy to EPIC-HF Trial. JACC Heart Fail. 2023 Nov;11(11):1579-1591. doi: 10.1016/j.jchf.2023.06.022. Epub 2023 Aug 16. PMID: 37589610.

Raja SG. Global trends and practices in coronary artery bypass surgery. Academia Medicine. 2025 Jul 16;2(3).

McMahon E, Chang YS. From surviving to thriving-parental experiences of hospitalised infants with congenital heart disease undergoing cardiac surgery: A qualitative synthesis. Journal of pediatric nursing. 2020 Mar 1;51:32-41.

Khera T, Murugappan KR, Leibowitz A, Bareli N, Shankar P, Gilleland S, Wilson K, Oren-Grinberg A, Novack V, Venkatachalam S, Rangasamy V. Ultrasound-guided pecto-intercostal fascial block for postoperative pain management in cardiac surgery: a prospective, randomized, placebo-controlled trial. Journal of cardiothoracic and vascular anesthesia. 2021 Mar 1;35(3):896-903.

Kumar AK, Chauhan S, Bhoi D, Kaushal B. Pectointercostal fascial block (PIFB) as a novel technique for postoperative pain management in patients undergoing cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2021 Jan 1;35(1):116-22.

Ng JY, Tan EF, Kemberi M, Urgesi E, Jubouri M, Bailey DM, Bashir M, Awad WI. EuroSCORE II: Current limitations and physiological gaps in risk stratification. Experimental Physiology. 2025 Jul 22.

Laghlam D, Lê MP, Srour A, Monsonego R, Estagnasié P, Brusset A, Squara P. Diaphragm dysfunction after cardiac surgery: reappraisal. Journal of Cardiothoracic and Vascular Anesthesia. 2021 Nov 1;35(11):3241-7.

Athar M, Parveen S, Yadav M, Siddiqui OA, Nasreen F, Ali S, Haseen MA. A randomized double-blind controlled trial to assess the efficacy of ultrasound-guided erector spinae plane block in cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2021 Dec 1;35(12):3574-80.

Kiriyama H, Daimon M, Nakanishi K, Kaneko H, Nakao T, Morimoto-Ichikawa R, Miyazaki S, Morita H, Daida H, Komuro I. Comparison between healthcare-associated and community-acquired infective endocarditis at tertiary care hospitals in Japan. Circulation Journal. 2020 Mar 25;84(4):670-6.

Lakhe G, Shrestha BB, Subedi A. Preoperative anxiety among patients undergoing elective surgery in a tertiary care centre: A descriptive cross-sectional study. JNMA: Journal of the Nepal Medical Association. 2022 Aug 31;60(252):681.

Gorini A, Giuliani M, L'Acqua C, Barbieri S, Sisillo E, Veglia F, Tremoli E. Associations of preoperative self-rated symptoms of anxiety and depression on length of hospital stay and long-term quality of life in patients undergoing cardiac surgery. Journal of Cardiovascular Nursing. 2022 May 1;37(3):213-20.

Migdady I, Rice C, Deshpande A, Hernandez AV, Price C, Whitman GJ, Geocadin RG, Cho SM. Brain injury and neurologic outcome in patients undergoing extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Critical care medicine. 2020 Jul 1;48(7):e611-9.

Cho L, Kibbe MR, Bakaeen F, Aggarwal NR, Davis MB, Karmalou T, Lawton JS, Ouzounian M, Preventza O, Russo AM, Shroyer AL. Cardiac surgery in women in the current era: what are the gaps in care?. Circulation. 2021 Oct 5;144(14):1172-85.

Sahajanandan R, Varsha AV, Kumar DS, Kuppusamy B, Karuppiah S, Shukla V, Thankachen R. Efficacy of paravertebral block in “Fast-tracking” pediatric cardiac surgery-Experiences from a tertiary care center. Annals of Cardiac Anaesthesia. 2021 Jan 1;24(1):24-9.

Downloads

Crossmark - Check for Updates

How to Cite

NIAZI, A. K. ., MAHMOOD, M. M. ., MIKRANI, B. ., SARWER, M. M. ., AKRAM, S. ., & YAQOOB, Z. . (2025). Neurological Complications in Patients Undergoing Cardiac Surgery: A Tertiary Care Experience. Pakistan Journal of Medical & Health Sciences, 19(12), 16–22. https://doi.org/10.53350/pjmhs020251912.4