Neurological complications of surgery of the aorta
Introduction. Improvement in cardiac surgery techniques has led to a considerable reduction in mortality following sur-gery of the aorta, dissection of the aorta and for aortic aneurysms. Although there are satisfactory vascular results following surgical repair, morbi-mortality related to neurological complications, both cerebral and spinal, is still very high. Repair of aortic lesions may lead to damage by two main mechanisms: ischemia secondary to prolonged obstruction of the aorta or to neurological lesions due to total circulatory arrest. Development. After description of the mechanisms leading to cerebral and spinal lesions and the risk factors involved, we discuss methods of vascular protection and other means of neuro-protection, both spinal and cerebral. Of the vascular techniques for spinal protection, the most useful ones are short-circuits, or active or passive shunts, and cardiopulmonary by-pass. Amongst the vascular techniques for cerebral protection we describe total circulatory arrest and methods of anterograde and retrograde cerebral perfusion, and when these may be used. As general measures for nervous system protection, we describe the use of hypothermia and drugs such as corticosteroids, free radical blockers, antagonists of the excitatory amino-acids etc. Conclusions. In spite of the number of studies done, the extreme sensitivity of the nervous system to ischemia has meant that in few cases have encouraging results been seen. Neurological damage continues to be the main cause of morbi-mortality in patients with dissection or aneurysm of the aorta
Desarrollo Tras la exposición de los mecanismos de la lesión medular y cerebral y sus factores de riesgo, analizamos los métodos de protección vascular y otras medidas de neuroprotección, tanto espinal como cerebral. Dentro de las técnicas vasculares de protección espinal son de especial interés los cortocircuitos o shunts activos o pasivos y el by-pass cardiopulmonar. Entre las técnicas vasculares de protección cerebral describiremos en qué consiste y cuándo se usa la parada circulatoria total y los métodos de perfusión cerebral anterógrada y retrógrada. Como medidas de protección neuronal general nos referiremos al uso de la hipotermia y fármacos como los corticosteroides, bloqueantes de radicales libres, antagonistas de aminoácidos excitadores, etc.
Conclusiones A pesar de los numerosos estudios, la gran sensibilidad del sistema nervioso a la isquemia ha provocado que en pocos casos se hayan obtenido resultados alentadores. El daño neurológico sigue siendo en la actualidad la principal causa de morbimortalidad en el sector de la población que sufre disección o aneurismas aórticos
