Neuro-psychological changes after open heart surgery

ABSTRACT

This is a prospective study on 67 consecutive randomly selected cases of different open heart operations. There were 52 males [77.6%] and 15 females [22.4%]. 36 patients [53.4%] had surgery for RHD, 19 [18.4%] for CHD, 11 IHD [16.4%], and one case of Bental's operation [1.45%]. Three cases had intraoperative mortality, two cases has immediate postoperative mortality, and 6 had late postoperative mortality, and 6 had late postoperative mortality, with a total mortality of 11 cases [16.4%]. Neurologic complications [NC] were reported in 11 cases [16.4%] [5/11 with clinical proof of neuropsychiatric complications [NPsC] and 6/11 with severe neurological insult ending in mortality which did not allow psychological assessment]. On the other hand, 4 cases reported pure psychiatric complications [PsC] [5.9%]. So, the total incidence of psychiatric complications with or without neurological involvement was 9 cases [14.5%] while the total incidence of neurological, psychological or both types of complications was 15 cases [22.4%]. The following risk factors were found to predispose to the incidence of neurological complications Among the preoperative factors, patients with RHD were found to be more affected than CHD and IHD. In the intraoperative factors, abnormal blood gases before bypass, prolonged total pump time, high mean blood pressure during bypass above 91.9 mmHg, low mean blood pressure during bypass less than 41.4 mmHg, significant operative accidents, and difficulty in wearing from heart lung machine. As regards, the postoperative factors; low postoperative mean blood pressure less than 61.6 mmHg, significant postoperative events, abnormal postoperative blood gases, abnormal postoperative acid base status, and abnormal regain of consciousness