局部进展期胃癌腹腔镜与开腹D2根治术后并发症危险因素分析

目的探讨进展期胃癌D：根治术后并发症发生的危险因素。方法南方医科大学附属南方医院普通外科自2004年6月至2011年5月连续收治局部进展期胃癌行D2根治术的患者483例,其中腹腔镜手术132例（27.3％）,开腹手术351例（72．7％）,术后并发症按照Clavien．Dindo外科并发症分级系统定义为总体并发症和严重并发症。多因素Logistic模型预测术后并发症的独立危险因素。结果483例患者术后并发症的总体发生率、严重并发症发生率和死亡率分别为12．4％（60／483）、2．5％（12／483）和0．2％（1／483）。腹腔镜手术与开腹手术在术后总体并发症发生率[13．6％（18／132）和12．O％（42／351）,P=0．620]和严重并发症的发生率[3．0％（4／132）和2．3％（8／351）,P=0．743]方面差异均无统计学意义。多因素分析结果显示,年龄大于或等于60岁、有术前合并症和术中失血量大于300ml是导致术后出现并发症的独立危险因素（P〈O．05）;其中,术中失血量大于300ml是术后发生严重并发症的独立危险因素。结论对于局部进展期胃癌腹腔镜D2根治术在技术上可行、安全。对于有术前合并症、术中失血超过300ml和老年患者要警惕术后并发症的发生。减少术中失血量,可能会降低术后严重并发症的发生率。     

影响小肠梗阻手术预后的危险因素分析

目的 评估影响经手术治疗的小肠梗阻患者预后的危险因素。方法回顾分析经手术治疗的193例小肠梗阻患者的临床资料。结果本组小肠梗阻的病因中肠粘连占38．9％,疝占37．8％：发生肠管绞窄者42．0％,肠管坏死者23．3％。总的并发症发生率为16．1％,术后30d内死亡率为4．1％。术后中位住院时间13d。70岁以上老年人（P=0．033）、糖尿病（P=0．017）、恶性肿瘤（P=0．003）、WBC超过15×10^9／L（P=0．017）和入院与手术间隔时间（P=0．039）是绞窄性肠梗阻高发生率的独立因素;老年（P=0．031）和恶性肿瘤（P=0．013）是手术死亡率增加的独立因素;老年（P=0．016）和肠切除（P=0．017）是增加并发症发生率的独立危险因素。结论老年患者小肠梗阻的肠管绞窄发生率、术后并发症发生率和手术死亡率显著增加。     

肝移植术后神经系统并发症28例分析

目的探讨肝移植术后神经系统并发症的种类、发病率及其相关因素。方法回顾性分析166例原位肝移植患者的临床资料，统计其中神经系统并发症种类及发生率。将患者按照有无神经系统并发症分为A组（有神经系统并发症）和B组（无神经系统并发症），分析神经系统并发症与性别、年龄、原发疾病、移植手术方式、手术时间、无肝期时问、供肝冷缺血时间、手术出血量、红细胞悬液输注量及手术后免疫抑制方案等因素的关系。结果166例肝移植受者发生神经系统并发症28例（32例次），发生率为16．9％；神经系统并发症种类包括脑病、癫痫、脑出血、中枢神经系统感染、严重锥体外系症状及周围神经病变；A、B两组患者在性别、年龄、移植手术方式、手术时间、无肝期时间、供肝冷缺血时间、手术出血量、红细胞悬液输注量及术后免疫抑制方案等方面相比较，差异无统计学意义。神经系统并发症与原发病密切相关，药物性肝功能衰竭患者神经系统并发症发生率高达30％，其中发生脑病的患者达15％；乙型肝炎后肝硬化患者的发生率为21％；原发性胆汁性肝硬化、肝细胞癌及Wilson病的发病率相近，分别为12．5％、16．7％和17．8％，肝细胞癌患者的周围神经病变发生率达10％。结论肝移植后神经系统并发症种类多，发生率高。神经系统并发症与原发疾病有重要关联，应引起临床重视。     

心脏手术后消化道并发症的原因分析

目的分析心脏手术后消化道并发症的临床特点,达到及时防治和实施护理干预为目的。方法回顾性分析本院2003年1月～2007年12月行心脏手术患者1415例的临床资料,分析手术后患者的消化道并发症特点,总结其高危因素、病变类型,并及时给予有效的预防和治疗措施。结果共有23例（1．63％）患者出现术后消化道并发症,其中以上消化道出血（12例,占52．18％）最多见。接受保守治疗19例（82．61％）,手术探查4例（17．39％）,死亡10例（43．48％）,上消化道出血和肝功能衰竭为最主要的致死原因。术后及时留置胃管和适当的胃肠减压,合理肠内营养,采取合适卧位等。结论心脏手术后消化系统功能障碍发生率低但死亡率高,消化系统病史、心功能、体外循环时间、机械通气及低心排综合征是其高危因素,合理有效的护理干预有利于病情转归。     

克罗恩病患者肠切除术后吻合口感染性并发症的危险因素分析

目的探讨影响克罗恩病（cD）患者肠切除术后吻合口感染性并发症发生的危险因素。方法回顾性分析1990年1月至2012年10月间在浙江省丽水市人民医院接受肠切除手术的114例CD患者的临床资料,分别通过x。检验和Logistic回归模型对术后发生吻合口感染性并发症的发生风险进行单因素和多因素分析。结果术后吻合口感染性并发症发生率为12．3％（14／114）,其中吻合口瘘7例,腹腔脓肿6例,肠外瘘1例。多因素分析显示,克罗恩病活动指数（CDAI）大于150（DR=2．185,95％CI：1．098～6．256）、术前使用甾体类药物（OR=2．674,95％C1：1．118—8．786）及合并腹腔脓肿和（或）瘘（OR=3．447,95％CI：1．254—10．462）是术后出现吻合口感染性并发症的独立高危因素（均P〈0．05）。无上述危险因素者术后吻合口感染性并发症发生率为5．7％（3／53）,有1个危险因素者为11．4％（4／35）,2个危险因素者21．1％（4／19）,3个危险因素者则可高达42．9％（3／7）。结论术前使用甾体类药物、CDAI大于150及合并腹腔脓肿和（或）瘘是CD肠切除术后出现吻合口感染性并发症的高危因素。如果这些危险因素术前无法消除,肠切除术后行一期吻合应持谨慎态度。     

36例心脏直视手术后心脏压塞

３６例心脏直视手术后心脏压塞阎玉生，龙国粹，李中学，李斌，童健心脏压塞是体外循环心脏直视手术后严重并发症之一，发生率为１．２％～３．４％［１］。１９８３年１月～１９９３年７月，我们共行体外循环心内直视手术５７５例，术后发生急性心脏压塞２９例，占５．０...     

克罗恩病复发再手术的并发症危险因素分析

目的探讨克罗恩病（CD）复发再手术后并发症的危险因素及其疗效。方法回顾性收集1995-2009年间在福建医科大学附属第一医院65例CD复发再手术患者的临床资料（再手术组）,对其术后并发症的危险因素进行分析。同时选取同期年龄匹配的65例CD初次手术患者（初次手术组）。比较再手术与初次手术的术中及术后情况。结果再手术组复发再手术后有25例（38．5％）出现并发症,显著高于初次手术者（12．3％）。术中行预防性肠造口的19例患者术后仅3例（15．8％）出现并发症,而未行预防性肠造口的46例患者有22例（47．8％）出现并发症,差异有统计学意义（Х^2=5．831,P=0．016）。与初次手术相比,再手术组手术时间更长、腹膜粘连更严重、术后住院时间更长（均P〈0．05）。结论CD复发再手术术式复杂．有着较高的术后并发症发生率。预防性肠造口有助于降低术后并发症发生率。     

腹腔镜可调节胃绑带术治疗单纯性肥胖症228例

目的评价腹腔镜可调节胃绑带术（LAGB）的减重效果及手术并发症。方法回顾性分析2003年6月至2011年6月间在上海第二军医大学长海医院普通外科同一组医师施行LAGB手术的228例单纯性肥胖症患者的临床资料，观察其术后减重效果及近、远期并发症。结果228例患者中女性155例，男性73例；年龄（32．5＋10．3）岁；术前体质量指数（39．5＋6．3）kg／m。。除1例因显露不佳致中转开腹，其余均经腹腔镜顺利完成手术。术后随访3～70（中位37）月，早期并发症发生率2．2％（5／228），远期并发症发生率32．9％（75／228），其中与绑带相关远期并发症发生率24．6％（56／228）。术后1、3、5年额外体质量减重率（wwL％）分别为（40．5＋30．5）％、（59．5~41．5）％和（58．9±46．4）％。术后1、3、5年EWL％大于50％者所占比例分别为32．8％（64／195）、54．4％（62／114）和54．8％（23／42），大于75％者所占比例分别为0、15．8％（18／114）和21．4％（9／42）。结论LAGB手术死亡率和早期并发症发生率非常低，但远期并发症发生率较高，且术后减重效果欠理想，不宜作为减重首选术式。     

肝移植术后神经系统并发症

目的 报道肝移植术后常见的神经系统并发症及其可能的原因。方法 对香港玛丽医院从１９９１年１１月到１９９８年８月的肝移植病例进行回顾性分析。结果 为７８位病人做了８０例肝移植，９例（１１％）发生神经系统并发症，４例为颅内出血，２例病人发生脑梗塞，２例病人发生癫痫发作，１例病人出现判断力的障碍，同神经系统并发症相关的死亡率为５％（４／８０）。术中大量输血（大于１万毫升）同肝移植术后颅内出血有明显的关系     

肝外伤的诊断和治疗

目的 探讨降低肝外伤治疗的并发症和死亡率的有效途径。方法：对１９７９年１月￣１９９８年１２月２０年连接１４６例肝外伤的资料,分前、后１０年两期进行回顾性对比分析。结果 １４６例肝外伤１３０例（８９％）采用手术治疗,１６例（１１％）采用非手术治疗（ＮＯＭ）。住院天数前１０年是２２．３８天,近１０年２１．４天,Ｐ〈０．０５）。与肝外伤直接相关的并发症发生率为２０．５％（３０例）,共４４例次,其中前１０     

Cerebral protection selection in aortic arch surgery for patients with preoperative complications of cerebrovascular disease.

OBJECTIVE: Retrograde perfusion is gaining acceptance as a means of cerebral protection, but it remains unclear how long the brain is protected and whether it is effective in patients with preoperative cerebrovascular disease. METHODS: From January 1989 to August 1999, 205 patients--118 male and 87 female patients who ranged 12 to 86 years old, mean: 65.5 years old--underwent surgery at our hospital for aortic arch aneurysm using cerebral protection. We focused on mortality, stroke incidence and perioperative risk factor between 2 groups--selective cerebral and retrograde cerebral perfusion--also studying patients with preoperative cerebrovascular disease that influenced postoperative stroke. RESULTS: The hospital mortality was 11.7% (selective cerebral perfusion group: 12%, retrograde group: 10.9%). Stroke occurred in 11 patients (5.3%), 4.7% in the selective cerebral perfusion group and 7.3% in the retrograde group. Preoperative cerebrovascular disease does not appear to be a risk factor for postoperative brain damage in aortic arch surgery. Regarding total replacement of the aortic arch, the incidence of postoperative brain damage in the retrograde group with preoperative cerebrovascular disease was higher than that in another group (p = 0.072). Cardiopulmonary bypass time and selective cerebral perfusion time in the patients with postoperative stroke were significantly longer than that in non-stroke group. CONCLUSIONS: Preoperative cerebrovascular disease did not appear to be a risk factor in postoperative neurological deficit in the selective cerebral perfusion group. Prolonged selective cerebral perfusion time and cardiopulmonary bypass time may, however, lead to brain edema and cause neurological deficit.     

The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass

Outcome after cardiac surgery varies depending on complication type. We therefore sought to determine the association between complication type, mortality, and length of stay in a large series of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Multivariate logistic regression was used to test for differences between complication types in mortality and prolonged length of stay (>10 days) while controlling for preoperative and intraoperative risk factors. In 2609 consecutive cardiac surgical patients requiring CPB, the mortality rate was 3.6%; 36.5% had one or more complications, and 15.7% experienced an adverse outcome (death or prolonged length of stay). Multivariate logistic regression demonstrated that complication type was significantly associated with adverse outcome (P < 0.001) independent of Parsonnet score and CPB time (c-index = 0.80). The development of noncardiac complications only (Group NC) and cardiac complications with other organ involvement (Group B) significantly increased mortality and hospital and intensive care unit length of stay (P < 0.001) when compared with cardiac complications only (Group C). The incidences of adverse outcome in Groups C, NC, and B were 15%, 43%, and 67%, respectively; the mortality rates were 3%, 7%, and 20%, respectively. All these intergroup comparisons were significantly different (adjusted P < 0.05). Complications involving organs other than the heart appear to be more deleterious than cardiac complications alone, underscoring the need for strategies to reduce noncardiac complications. IMPLICATIONS: Complications, particularly when they involve organs other than just the heart, increase mortality and prolong the length of hospital stay after heart surgery, independent of a patient's preoperative risk factors and the duration of cardiopulmonary bypass. Strategies aimed at preventing damage to other organs during cardiac surgery need to be improved.     

'No touch' techniques for porcelain ascending aorta: comparison between cardiopulmonary bypass with femoral artery cannulation and off-pump myocardial revascularization

BACKGROUND: Detection of severe atherosclerotic ascending aorta during coronary artery bypass grafting requires alterations in the standard surgical technique to reduce the probability of stroke-related atheroembolization. Off-pump coronary artery bypass grafting (OPCAB) confers the benefits of avoiding aortic cannulation and clamping, and may therefore attenuate this risk. METHODS: OPCAB (n = 41) was compared to cardiopulmonary bypass (CPB) using femoral arterial cannulation and hypothermic fibrillatory arrest (n = 15), in patients with porcelain ascending aorta undergoing myocardial revascularization. In both groups, a 'no touch' technique was applied by avoiding aortic cannulation and clamping. Proximal anastomoses on the atherosclerotic aorta were avoided by arterial grafting, (in-situ or T-graft configurations) in all cases. RESULTS: Operative mortality was comparable (2.4% and 6.6% in the OPCAB and CPB groups respectively, p = NS). The rate of adverse neurological events, (two strokes and one transient ischemic attack), was higher in the CPB group (p = 0.0164). Based on brain CT, the nature of the recorded stroke suggested retrograde emboli. Three year survival (Kaplan-Meier) for the OPCAB and CPB groups was 86.7% and 81.3%, respectively (p = NS). Occurrence of late neurological adverse events during follow-up (8-51 months) was similar. CONCLUSIONS: In patients with porcelain ascending aorta undergoing myocardial revascularization, neurological outcome of OPCAB patients is better than CPB using femoral artery cannulation.     

Clinical significance of serum S-100β protein level after pediatric cardiac surgery

OBJECTIVE: The serum S-100 beta protein level is a specific marker of damage to the central nerve system (CNS). We studied its significance in pediatric cardiac surgery as a possible marker of CNS damage. METHODS: Subjects were 18 consecutive pediatric patients aged 12 days to 13 years (mean: 2.8 years) undergoing open-heart surgery. We measured the serum S-100 beta protein level using ELISA (SRL Co. Ltd., Tokyo) immediately after inducing anesthesia and immediately, 12 hours, and 24 hours after weaning from cardiopulmonary bypass (CPB). RESULTS: None had postoperative neurological symptoms. The prebypass serum S-100 beta protein level showed a significant logarithmic correlation with patient age. All patients showed increased S-100 beta protein immediately after weaning from CPB, and multiple regression analysis showed that bypass time and cyanosis were significant factors in such as increase. Cyanosis was the only factor in increased S-100 beta protein levels 12 and 24 hours after weaning from CPB. The peak S-100 beta protein level showed a significant exponential correlation with bypass time. CONCLUSION: Serum S-100 beta protein elevated immediately after weaning from CPB correlated with bypass time but not with neurological symptoms. Physiological changes other than substantial brain damage caused by CPB may increase the serum S-100 beta protein level. Prebypass data on neonates and infants showed serum S-100 beta protein increased without brain damage supporting this hypothesis.     

S100B Blood Levels Correlate with Rewarming Time and Cerebral Doppler in Pediatric Open Heart Surgery

Abstract Background: Brain hyperthermia, accompanying the rewarming phase of cardiopulmonary bypass (CPB), has been involved in the genesis of postoperative brain damage. Blood S100B levels are emerging as a marker of brain distress, and could offer a reliable monitoring tool at different times during and after open heart surgery. Methods: Thirty‐two patients undergoing repair of congenital heart disease with CPB and deep hypothermic circulatory arrest (DHCA) were monitored by S100B blood levels and middle cerebral artery Doppler velocimetry pulsatility index (MCA PI) before, during, and after surgical procedure at five predetermined time‐points. Results: Both S100B and MCA PI significantly increased, MCA PI values exhibiting a peak at the end of surgery time‐point (p > 0.05), while S100B blood levels were increased at the end of CPB (p < 0.05). Multivariate analysis, with S100B levels measured at the end of CPB as dependent variable, showed a positive significant correlation with MCA PI (p # 0.04), with the CPB and the rewarming duration (p # 0.03 and p # 0.009, respectively). Conclusions: The present results show a significant correlation between a biochemical marker of brain damage and an index of increased cerebrovascular resistance, with higher levels during the rewarming CPB phase in pediatric open heart surgery.     

S100B blood levels correlate with rewarming time and cerebral Doppler in pediatric open heart surgery

BACKGROUND: Brain hyperthermia, accompanying the rewarming phase of cardiopulmonary bypass (CPB), has been involved in the genesis of postoperative brain damage. Blood S100B levels are emerging as a marker of brain distress, and could offer a reliable monitoring tool at different times during and after open heart surgery. METHODS: Thirty-two patients undergoing repair of congenital heart disease with CPB and deep hypothermic circulatory arrest (DHCA) were monitored by S100B blood levels and middle cerebral artery Doppler velocimetry pulsatility index (MCA PI) before, during, and after surgical procedure at five predetermined time-points. RESULTS: Both S100B and MCA PI significantly increased, MCA PI values exhibiting a peak at the end of surgery time-point (p > 0.05), while S100B blood levels were increased at the end of CPB (p < 0.05). Multivariate analysis, with S100B levels measured at the end of CPB as dependent variable, showed a positive significant correlation with MCA PI (p = 0.04), with the CPB and the rewarming duration (p = 0.03 and p = 0.009, respectively). CONCLUSIONS: The present results show a significant correlation between a biochemical marker of brain damage and an index of increased cerebrovascular resistance, with higher levels during the rewarming CPB phase in pediatric open heart surgery.     

‘No Touch’ Techniques for Porcelain Ascending Aorta: Comparison Between Cardiopulmonary Bypass with Femoral Artery Cannulation and Off‐Pump Myocardial Revascularization

Abstract Background: Detection of severe atherosclerotic ascending aorta during coronary artery bypass grafting requires alterations in the standard surgical technique to reduce the probability of stroke‐related atheroembolization. Off‐pump coronary artery bypass grafting (OPCAB) confers the benefits of avoiding aortic cannulation and clamping, and may therefore attenuate this risk. Methods: OPCAB (n # 41) was compared to cardiopulmonary bypass (CPB) using femoral arterial cannulation and hypothermic fibrillatory arrest (n = 15), in patients with porcelain ascending aorta undergoing myocardial revascularization. In both groups, a ‘no touchrsquo; technique was applied by avoiding aortic cannulation and clamping. Proximal anastomoses on the atherosclerotic aorta were avoided by arterial grafting, (in‐situ or T‐graft configurations) in all cases. Results: Operative mortality was comparable (2.4% and 6.6% in the OPCAB and CPB groups respectively, p # NS). The rate of adverse neurological events, (two strokes and one transient ischemic attack), was higher in the CPB group (p # 0.0164). Based on brain CT, the nature of the recorded stroke suggested retrograde emboli. Three year survival (Kaplan‐Meier) for the OPCAB and CPB groups was 86.7% and 81.3%, respectively (p = NS). Occurrence of late neurological adverse events during follow‐up (8–51 months) was similar. Conclusions: In patients with porcelain ascending aorta undergoing myocardial revascularization, neurological outcome of OPCAB patients is better than CPB using femoral artery cannulation.     

Adult cardiac surgery outcomes: role of the pump type.

OBJECTIVE: This study was carried out to evaluate whether the type of pump used for cardiopulmonary bypass (CPB; roller vs. centrifugal) can affect mortality or the neurological outcomes of adult cardiac surgery patients. METHODS: Between 1994 and June 1999, 4000 consecutive patients underwent coronary and/or valve surgery at our hospital; of these, 2213 (55.3%) underwent surgery with centrifugal pump use, while 1787 (44.7%) were operated on with a roller pump. The effect of the type of the pump and of 36 preoperative and intraoperative risk factors for perioperative death, permanent neurological deficit and coma were assessed using univariate and multivariate analyses. RESULTS: The overall in-hospital mortality rate was 2.2% (88/4000), permanent neurological deficit occurred in 2.0% (81/4000) of patients, and coma in 1.3% (52/4000). There was no difference in hospital mortality between patients operated with the use of centrifugal pumps and those operated with roller pumps (50/2213 (2.3%) vs. 38/1787 (2.1%); P=0.86). On the other hand, patients who underwent surgery with centrifugal pumps had lower permanent neurological deficit (34/2213, (1.5%) vs. 47/1787 (2.6%); P=0.020) and coma (20/2213 (0.9%) vs. 32/1787 (1.8%); P=0.020) rates than patients operated with roller pumps. Multivariate analysis showed CPB time, previous TIA and age as risk factors for permanent neurological deficit, while centrifugal pump use emerged as protective. Multivariate risk factors for coma were CPB time, previous vascular surgery and age, while centrifugal pump use was protective. CONCLUSIONS: Centrifugal pump use is associated with a reduced rate of major neurological complications in adult cardiac surgery, although this is not paralleled by a decrease in in-hospital mortality.     

Independent association of preoperative hyperuricemia with acute kidney injury after cardiac surgery with cardiopulmonary bypass

Objective To investigate the impact of preoperative hyperuricemia on acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Methods A total of 567 adult patients undergoing cardiac surgery with CPB were enrolled to conduct a retrospective cohort database analysis. The patients were divided into hyperuricemia group and non-hyperuricemia group according to preoperative serum uric acid, and the incidence of AKI in two groups were compared. Binary logistic regression analysis was used to evaluate the relationship between preoperative hyperuricemia and AKI. Results Among 567 patients after cardiac surgery with CPB, hyperuricemia occurred in 303 cases (53.4%), and AKI occurred in 217 cases (38.3%). There was significant difference in the incidence of AKI between hyperuricemia group and non-hyperuricemia group (44.6% vs 31.1%, χ2=10.874, P=0.001). The duration of intensive care unit (ICU) stay and the length of stay were longer in hyperuricemia group than those in non-hyperuricemia group (both P＜0.05). After adjusting for age, gender, comorbidities (hypertension, diabetes mellitus, cerebrovascular disease), preoperative renal function, preoperative heart function, CPB time, intraoperative aortic block time, type of cardiac surgery and postoperative hypotension, binary logistic regression analysis showed that preoperative hyperuricemia was an independent risk factor of AKI after cardiac surgery with CPB (OR=1.912, 95%CI 1.270-2.879, P=0.002). Conclusion AKI is a common complication following cardiac surgery with CPB, and hyperuricemia is independently associated with CPB-associated AKI. Hyperuricemia may be involved in the pathogenesis of AKI, and intervention before cardiac surgery may be beneficial to prevent postoperative AKI.     

Risk factor analysis of early and delayed cerebral complications after cardiac surgery

OBJECTIVE: To report the incidence, severity, and possible risk factors for early and delayed cerebral complications. DESIGN: Retrospective study. SETTING: Link?ping University Hospital, Sweden. PARTICIPANTS: Consecutive patients who underwent cardiac surgery in the period July 1996 through June 2000 (n = 3,282). INTERVENTIONS: A standard cardiopulmonary bypass (CPB) technique was used for most patients. Postoperative anticoagulant treatment included heparin or anti-Xa dalteparin. Patients undergoing coronary artery bypass graft surgery received acetylsalicylic acid, and patients undergoing valve surgery received warfarin. MEASUREMENTS AND MAIN RESULTS: Cerebral complications occurred in 107 patients (3.3%). Of these, 60 (1.8%) were early, and 33 (1.0%) were delayed, and in 14 (0.4%) patients the onset was unknown. There were 37 variables in univariate analysis (p < 0.15) and 14 variables in multivariate analysis (p < 0.05) associated with cerebral complications. Predictors of early cerebral complications were older age, preoperative hypertension, aortic aneurysm surgery, prolonged CPB time, hypotension at CPB completion and soon after CPB, and postoperative arrhythmia and supraventricular tachyarrhythmia. Predictors of delayed cerebral complications were female gender, diabetes, previous cerebrovascular disease, combined valve surgery and coronary artery bypass graft surgery, postoperative supraventricular tachyarrhythmia, and prolonged ventilator support. Early cerebral complications seem to be more serious, with more permanent deficits and a higher overall mortality (35.0% v 18.2%). CONCLUSION: Most cerebral complications had an early onset. The results of this study suggest that aggressive antiarrhythmic treatment and blood pressure control may imfurther prove the cerebral outcome after cardiac surgery.