Brain injury remains one of the most dreaded complications of cardiac surgery. The range of injury is broad; while a stroke may be easily defined and diagnosed, more subtle injuries most definitely occur. There remains debate as to how these are diagnosed and there is a lack of standard definitions allowing inter-study comparison. If we are to have confidence in strategies that may reduce brain injury, we need to have confidence in the end-points used to define that injury. We need to better understand the phenomena associated with neuropsychometric testing; we need to fully elucidate the relationship between structural brain injury, embolism counting, and surrogate biomarkers; and we need an improved understanding of the clinical significance of abnormalities detected on postoperative magnetic resonance imaging. Brain Protection in Cardiac Surgery presents a detailed background of studies of neurological morbidity and neuroprotection from a range of experts in the field of neuroprotection, providing a detailed reference for clinicians in the field. The Editors have detailed connections between the different strands of injury — be it the pathology, the imaging, the clinical and cognitive examination, potential biomarkers — and have then provided summary reports of treatment strategies that may reduce such injury. As we look to the future, the design of studies attempting to reduce such injury becomes increasingly important and this book provides the fundamental background information to fuel interest, initiate novel prevention and therapeutic strategies, and inform the investigator how to develop and design their research study.
Author(s): Eric S. Weiss, William A. Baumgartner (auth.), Robert S. Bonser, Domenico Pagano, Axel Haverich (eds.)
Edition: 1
Publisher: Springer-Verlag London
Year: 2011
Language: English
Pages: 246
Tags: Cardiac Surgery; Cardiology; Neurology; Neuroradiology; Imaging / Radiology; Internal Medicine
Front Matter....Pages i-xv
Molecular and Biochemical Basis of Brain Injury Following Heart Surgery – Interventions for the Future....Pages 1-10
Cardiopulmonary Bypass Circuit and the Brain....Pages 11-18
Neurological and Cognitive Sequelae of Cardiac Surgery....Pages 19-28
Neurocognitive Decline Following Cardiac Surgery: Incidence, Risk Factors, Prevention, and Outcomes....Pages 29-36
Neuropathology of Brain Injury in Cardiac Surgery....Pages 37-44
Biochemical Markers of Brain Injury....Pages 45-55
Pitfalls of Neuropsychometric Assessment and Alternative Investigative Approaches....Pages 57-64
Imaging of the Brain in Cardiac Surgery as a Tool in Brain Protection Studies....Pages 65-72
Current Techniques of Emboli Detection and Their Utility in Brain Protection Studies....Pages 73-81
Intraoperative Brain Monitoring in Cardiac Surgery....Pages 83-111
Near-Infrared Spectroscopy Monitoring in Cardiac Surgery: Theory, Practice, and Utility....Pages 113-129
The Design and Methodology of Clinical Studies of Neuroprotection in Cardiac Surgery....Pages 131-140
Temperature and Brain Protection in Cardiac Surgery....Pages 141-157
Studies of Nonpharmacological Interventions to Reduce Brain Injury....Pages 159-175
Pharmacological Studies to Reduce Brain Injury in Cardiac Surgery....Pages 177-189
Off-Pump and On-Pump Coronary Artery Surgery and the Brain....Pages 191-205
Experimental Basis and Clinical Studies of Brain Protection in Pediatric Heart Surgery....Pages 207-217
Experimental Basis and Clinical Studies of Brain Protection in Aortic Arch Surgery....Pages 219-228
The Future of Brain Protection in Cardiac Surgery....Pages 229-237
Back Matter....Pages 239-246
