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J Thorac Cardiovasc Surg 1996;112:962-972
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

DETECTION OF STROKE DURING CARDIAC OPERATIONS WITH SOMATOSENSORY EVOKED RESPONSES

M.M.S. was supported by National Institute of Neurologic Diseases Clinical Investigator Development Award NS01502.

Received for publication March 20, 1996 Revisions requested May 8, 1996; revisions received May 21, 1996 Accepted for publication June 4, 1996. Address for reprints: Mark M. Stecker, MD, PhD, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283.

Abstract

Objectives: The objectives of this study were to determine if monitoring of intraoperative somatosensory evoked potentials could be used to detect stroke during cardiac operations and to establish indicators of cerebral ischemia based on changes in these potentials. Methods: Twenty-five patients undergoing cardiac operations underwent preoperative and postoperative neurologic examinations as well as intraoperative recording of somatosensory evoked potentials. Detailed analysis of the waveforms of these potentials was performed. Results: Two of the 25 patients had intraoperative strokes. These patients and only these patients had changes in their somatosensory evoked potentials during the operation suggesting cerebral ischemia. The unilateral disappearance of the cortical somatosensory evoked potential waves correlated significantly with the clinical outcome of stroke (p < 0.004). Ischemic changes were detected in real time and were related to the removal of the aortic crossclamp in one patient and to the initiation of cardiopulmonary bypass in the other. Conclusions: Somatosensory evoked potentials can detect intraoperative stroke during cardiac operations. Acute, unilateral decreases in amplitude of the cortical potential are more useful than changes in latency in detecting intraoperative stroke. (J THORAC CARDIOVASC SURG 1996;112:962-72)

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