**1. Introduction**

186 Aortic Valve Surgery

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J.B., Thompson, C., Moss, R., Carere, R., Munt, B., Nietlispach, F., & Humphries, K. (2009). Transcatheter aortic valve implantation. Impact on clinical and valve-related Around the second decade of the twentieth century there was speculation about the possibility of cardiac surgery and its possible consequences in the central nervous system. To reduce these potential consequences as much as possible, research was carried out into three different approaches: systemic hypothermia, by placing the patient in a bath of icecold water, cross circulation between two people, and cardiopulmonary bypass (CPB) with a roller pump and an artificial oxygenator (Clau Terré, 2009). Shortly after using these procedures, it became clear there was an advantage provided by the CPB technique with an independent oxygenator and normal systemic flows that neither cross-circulation nor surface hypothermia could provide. It thus became possible to address increasingly complex congenital heart disease and ventricular septal defects, tetralogy of Fallot and other more complex examples. With the introduction of CPB, early neurological complications such as coma, cognitive impairment, strokes, etc. began to appear.

Fig. 1. Extracorporeal (CPB) blood pump

Neurological Complications in Aortic Valve Surgery and Rehabilitation Treatment Used 189

The average cerebral blood flow in adult CPB is 25 ml/100g/min, which is approximately 6% of systemic flow. The ability for self-regulation with normotension persists, even in cases of hypothermia, ranging between 50 and 155 mm Hg. A decrease below 40 mm Hg may

The series that we can see in the bibliography show that there is a greater number of NCs in valve replacement surgery than in coronary artery bypass grafting, with an incidence of stroke or transient ischemic attack of 1.7% in patients undergoing coronary artery bypass grafting, 3.6% in those with a simple valve replacement, 3.3% in those undergoing both procedures and 6.7% in those who undergo a multiple valve replacement (Boeken et al.,

The NCs in these patients may affect the brain, the spinal cord and peripheral nerves, and the most common of these are often strokes, anoxic-ischemic encephalopathy, epilepsy and

Among the many threats to which the Nervous System is subjected during cardiovascular surgery, we can highlight the following: embolism, CPB, general anaesthetics, hypothermia, aortic clamping, and in some cases circulatory arrest. (Mills, 1995; Roach et al., 1996; Hallow

According to the guidelines of the American College of Cardiology / American Heart Association as regards heart surgery for 1999, neurological complications are classified as type I deficiency, including focal lesions such as stroke and stupor or coma, and type II when intellectual functioning and memory are affected, and seizures. However, there are

**Strokes** or **cerebrovascular accidents** are on the whole 80% ischemic and 20% hemorrhagic (use of anticoagulants). 50% of the ischemic ones are usually caused by atherothrombotic reasons, 25% are lacunar (associated with chronic arterial high blood pressure), 20% are cardioembolic, and the remaining 5% involve the ones we usually include in cardiac surgery: heart attacks in the border zone area between the anterior cerebral artery and the middle cerebral artery (called man-in-the-barrel syndrome due to its clinical consequences),

In cardiac surgery, the incidence of stroke ranges from 0.7 to 3.8% when assessed retrospectively or between 4.8 to 5.2% if assessed prospectively (Bocerius, 2004). This is the main cause of morbidity in people undergoing cardiac surgery. Its frequency is 5% higher in patients with valvular disease, either due to an increased frequency of atrial fibrillation in these cases or because the valve surgery requires opening the heart chambers and increases

It may appear early on, occurring during surgery, and become apparent when the patient awakes, or later after normal awakening with no focal neurological damage apparent. Both the early and late kinds have a high hospital mortality of 41% and 13% respectively. (Hogue

Strokes cause major disability and high rehabilitation costs because these patients most often require the use of different technical aids or orthotics for walking, wheelchairs, adaptation of their home due to architectural barriers, help from third parties and in some cases the everyday need for health care staff, requiring admission to specialised homes.

cause a significant decrease in cerebral oxygen delivery.

2005)

et al, 1999).

et al, 1999).

brachial plexus injuries

**3. Etiological classification of neurological complications** 

intermediate forms that are difficult to classify (Roach et al., 1996).

and between the latter and the posterior cerebral artery. (Sanz et al., 2008)

the likelihood of air embolization, unlike in coronary surgery.

Neurological complications (NC) associated with postoperative aortic valve surgery are relatively frequent in spite of technical advances in surgery and CPB systems, and they give rise to an increase in morbidity and mortality, increased lengths of stays in hospital and rising costs after discharge from hospital. Therefore, the main purpose of the medical team responsible for assessing and treating patients who require cardiac surgery is to conduct a proper assessment and preventive measures for these complications and, once they have occurred, to minimise the physical, psychological, social and economic consequences for the patient and their family.
