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Left hemispheric strokes in coronary surgery: implications for end-hole aortic cannulas
1Division of Cardiothoracic Surgery, Western Pennsylvania Hospital, Pittsburgh, USA. gswmd@aol.com
The Annals of Thoracic Surgery
|February 24, 2001
Summary
Perioperative stroke (POS) after coronary artery bypass grafting (CABG) predominantly affects the left side of the brain. This finding suggests end-hole aortic catheters, not aortic manipulation, may be the primary cause of POS.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Medical Complications
Background:
- Perioperative stroke (POS) is a severe complication following coronary artery bypass grafting (CABG).
- Previous research has not determined the laterality of brain involvement in POS.
- This study investigates the side of the brain most frequently affected by stroke after CABG.
Purpose of the Study:
- To determine the incidence and laterality of perioperative strokes in patients undergoing coronary artery bypass grafting (CABG).
- To explore potential causes of perioperative stroke (POS) based on stroke laterality.
Main Methods:
- A prospective study of 2,217 consecutive coronary artery bypass grafting (CABG) patients from 1996 to 1998.
- Strokes were classified as perioperative (within 3 days) or late (during hospitalization).
- Analysis of stroke laterality (left, right, bilateral, etc.).
Main Results:
- A total of 51 strokes (2.3%) occurred in 2,217 patients.
- Left-sided strokes were most common, accounting for 75% (18 of 24) of major territorial perioperative strokes.
- Stroke patients were significantly younger than non-stroke patients.
Conclusions:
- The high incidence of left-sided strokes suggests end-hole aortic perfusion catheters are a likely cause of POS.
- This contrasts with theories implicating aortic clamping or manipulation, which would predict right-sided strokes.
- Utilizing side-hole aortic cannulas may potentially decrease the occurrence of POS.