**7. Materials and methods**

452 patients who underwent aortic valve surgery were retrospectively analyzed by being divided into the following groups: single and multiple aortic valve replacements, aortic

Neurological Complications in Aortic Valve Surgery and Rehabilitation Treatment Used 197


















diagnosed or treated with medication, a diet or exercise by a doctor

been diagnosed or treated with medication or chest physiotherapy.

no response to verbal or visual stimuli.

motor functions, seizures and psychiatric disorders

by a doctor with medication, a diet or exercise.


consumers of cigarettes (>2500 cigarettes/person/ year).

doctor with medication, a diet or exercise.

ray, dyspnea, or ventricular gallop.

valves that were operated on.

with a cardiovascular emergency).

immobilization.

reversible.

alcohol.

amputation.

severe <30%.

kinesitherapy.

valve replacement plus coronary artery bypass grafting and aortic valve replacement plus tube graft due to root aneurysm between January 2008 and November 2010.

Fig. 7. Reimplantation using the inclusion (David) technique

An NC was defined as the occurrence of a cerebrovascular accident (STROKE) (ischemic or hemorrhagic), transient ischemic attack (TIA), spinal cord injury, peripheral neuropathy, seizure, stupor, coma, polyneuropathy of critically ill patient, dementia, acute delirium or encephalopathy.

A comparative analysis was carried out on the incidence of NCs according to a series of preoperative and postoperative clinical variables: arterial hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, heart failure, renal failure, prior STROKE, smoker, drinker, calcified valves, endocarditis, peripheral arterial disease, previous revascularization, aortic atherosclerosis, acute myocardial infarction within 3 months prior to surgery, left ventricle ejection fraction, aortic clamping time and CPB time, postoperative arrhythmia, number of transfusions required, whether resuscitation techniques were required, drugs the patients were taking, surgical priority (scheduled, priority and urgent) and type of surgery performed.

An attempt was made to determine which of these variables was more important statistically in relation to the others.

### **7.1 Definitions used**


valve replacement plus coronary artery bypass grafting and aortic valve replacement plus

An NC was defined as the occurrence of a cerebrovascular accident (STROKE) (ischemic or hemorrhagic), transient ischemic attack (TIA), spinal cord injury, peripheral neuropathy, seizure, stupor, coma, polyneuropathy of critically ill patient, dementia, acute delirium or

A comparative analysis was carried out on the incidence of NCs according to a series of preoperative and postoperative clinical variables: arterial hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, heart failure, renal failure, prior STROKE, smoker, drinker, calcified valves, endocarditis, peripheral arterial disease, previous revascularization, aortic atherosclerosis, acute myocardial infarction within 3 months prior to surgery, left ventricle ejection fraction, aortic clamping time and CPB time, postoperative arrhythmia, number of transfusions required, whether resuscitation techniques were required, drugs the patients were taking, surgical priority (scheduled,

An attempt was made to determine which of these variables was more important







haemorrhage persisting longer than 24 hours or which leaves side-effects.

tube graft due to root aneurysm between January 2008 and November 2010.

Fig. 7. Reimplantation using the inclusion (David) technique

priority and urgent) and type of surgery performed.

statistically in relation to the others.

motor, speech or sight functions.

hours and with no side-effects.

without loss of consciousness.

**7.1 Definitions used** 

mobility

mutism.

encephalopathy.


Neurological Complications in Aortic Valve Surgery and Rehabilitation Treatment Used 199

actinomyces odontolyticus, Granulicatella, pseudomonas aeruginosa, staphylococcus epidermidis, S. pneumoniae, 2 cases reported as Gram strains and two other cases as

**Drugs Anti AHT Sintrom Diuretics Hypolipemiant Antiplatelet OAD/Insulin**  % 67 18.1 34.3 42.5 29.9 17.5

NC STROKE TIA SCI PN Seizure Stupor Coma CIP ACS Encephalopathy % 1.5 0.67 0.4 0.2 1.3 1.3 0.4 1.1 6.6 5 Table 3. Percentages of NCs (neurological complications): TIA (transient ischemic attack), SCI Spinal Cord Injury, PN (peripheral neuropathy), CIP (critical illness polyneuropathy),

Table 3 shows the percentages of different NCs in Ao valve surgery. The rate of strokes was 1.5%, corresponding to 7 cases. Of these 7 cases, 2 came from the 71 patients who underwent valve replacement + CABG AO (2.8%), 3 were from the 227 patients that underwent single Ao valve replacement surgery (1.3%), one case was from the 72 patients who underwent multiple valve replacement (1.4%) and finally there was one case from the 12 patients who underwent a 2nd Ao valve replacement (8.3%). Table 4 shows the three most common NCs that have been seen in this study according to the different surgical techniques and the

Of the 23 cases of encephalopathy, 17.4% had a metabolic cause, in 56.5% the cause was hypoxic-ischemic and 26% had various causes. Of the strokes, 57.1% were right hemisphere and 42.9% were on the left. There was only one case in which the stroke was haemorrhagic. Of the ischemia (6 cases - 85.7%), 4 were of cardioembolic origin (66.6%), 2 border territory

Replacement + CBPG 71 2(2.8) 8(11.3) 5(7) 128.5 105.7 1 Ao valve replacement 227 3(1.3) 12(5.3) 6(2.6) 96.5 75.4 Multiple vv replacement 72 1(1,4) 4(5.5) 5(6,9) 151.2 126.8 Ao root repl. (Bentall) 58 0 5(8.6) 5(8.6) 148.2 118.2 Ao root repl. (David) 10 0 0 0 133.6 129.2 2nd Ao valve repl. 12 1(8,3) 3(25) 2(16.6) 166.2 127.3 Endoscopic valve repl. 2 0 0 0 - - Table 4. Most common NC percentages according to the different techniques used. Ao (aorta), vv (valve), repl (replacement), n: total number of patients, ACS (acute confusional syndrome). T. CPB (cardiopulmonary bypass time measured in minutes), T. Clamp (aortic clamping

There are only 2 cases described of spinal cord injury. One was a side effect of Ao valve replacement surgery and the other came after surgery for aortic arch replacement using the Bentall technique. The two cases were side effects to a spinal cord ischemia. One was a ASIA

**CPB** 

**T. Clamp** 

Table 2. Drugs used by patients with operation on the Ao valve

average times for CPB and Ao clamping measured in minutes.

(33.3%) (Man in the Barrel Syndrome) and one was lacunar (16.6%).

time measured in minutes). CBPG (coronary artery bypass grafting)

**Type of surgery n Stroke ACS Encephalopathy T.** 

undetermined.

ACS (confusional syndrome)

