From the Research
Patients with Posterior Reversible Encephalopathy Syndrome (PRES) can undergo open heart surgery, but careful consideration and management are required, with the most recent and highest quality study suggesting that strict blood pressure management is crucial during the perioperative period 1. The decision to proceed with open heart surgery in patients with PRES should be individualized based on the patient's current neurological status, the severity of PRES, and the urgency of cardiac surgery. Ideally, surgery should be delayed until PRES has resolved, which typically occurs within days to weeks with proper blood pressure control and removal of triggering factors. Some key points to consider in the management of PRES patients undergoing open heart surgery include:
- Strict blood pressure management during the perioperative period, with systolic blood pressure typically maintained below 140-160 mmHg using medications like nicardipine, labetalol, or clevidipine 1.
- Avoiding excessive blood pressure fluctuations and maintaining cerebral perfusion, as cardiopulmonary bypass during open heart surgery can cause blood pressure fluctuations and inflammatory responses that could potentially worsen PRES or delay recovery 2.
- Early recognition of the signs and symptoms of PRES, particularly identifying and treating high blood pressure, can prevent permanent neurologic disability 3. PRES is characterized by vasogenic edema in the posterior brain regions due to endothelial dysfunction and blood-brain barrier disruption, often triggered by severe hypertension, immunosuppressive drugs, or autoimmune conditions, and the overall prognosis is favorable, with clinical symptoms and imaging lesions being reversible in most patients 4, 5.