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Risk factor analysis of early and delayed cerebral complications after cardiac surgery
Lisa Ridderstolpe1, Ewa Ahlgren, Hans Gill
1Department of Biomedical Engineering/Medical Informatics, Linköping University, and the Department of Cardiothoracic Surgery and Anesthesia, Linköping Heart Center, University Hospital, Linköping, Sweden.
Objective:
To report the incidence, severity, and possible risk factors for early and delayed cerebral complications.
Design:
Retrospective study.
Setting:
Linköping 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.