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Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients
Jan Bucerius1, Jan F Gummert, Michael A Borger
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. bucerj@medizin.uni-leipzig.de
Insights
Stroke after cardiac surgery is a serious risk. Key predictors include prior vascular disease, diabetes, hypertension, and longer bypass times. Beating heart surgery may reduce stroke incidence.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Stroke is a significant complication following cardiac surgery.
- Despite advances, perioperative stroke remains a concern.
- Understanding stroke predictors is crucial for prevention.
Purpose of the Study:
- To identify predictors of stroke in a large cardiac surgery cohort.
- To analyze stroke incidence across various cardiac procedures.
- To evaluate the impact of surgical techniques on stroke risk.
Main Methods:
- Prospective data from 16,184 cardiac surgery patients (1996-2001).
- Inclusion of coronary artery bypass grafting (CABG), valve surgery, and combined procedures.
- Univariate and multivariate analyses to determine stroke predictors.
Main Results:
- Overall stroke incidence was 4.6%, varying by procedure (e.g., 3.8% for CABG, 9.7% for double/triple valve).
- Ten independent predictors identified: cerebrovascular disease, peripheral vascular disease, diabetes, hypertension, prior surgery, infection, urgent status, CPB >2 hours, hemofiltration, high transfusion.
- Beating heart CABG showed a lower stroke incidence.
Conclusions:
- Identifying stroke predictors aids in understanding pathogenesis and developing preventative strategies.
- Beating heart CABG is associated with a reduced stroke incidence.
- Further research may confirm beating heart surgery's role in improving patient outcomes.
Background:
Stroke remains a devastating complication after cardiac surgical procedures despite advances in perioperative monitoring and management. The purpose of this study was to determine the predictors of stroke in a large, contemporary cardiac surgery population.
Methods:
Prospective data on 16,184 consecutive patients undergoing cardiac surgery (coronary artery bypass grafting [CABG], n = 8,917; beating heart CABG, n = 1,842; aortic valve surgery, n = 1,830; mitral valve surgery, n = 708; double or triple valve surgery, n = 381; CABG and valve surgery, n = 2,506) between April 1996 and August 2001 were subjected to univariate and multivariate analysis. Stroke was defined as any new permanent (manifest stroke) or temporary neurologic deficit or deterioration (transient ischemic attack or prolonged reversible ischemic neurologic deficit) and was confirmed by computed tomography or magnetic resonance imaging whenever possible.
Results:
Overall incidence of stroke was 4.6% and varied between surgical procedures (CABG 3.8%; beating-heart CABG 1.9%; aortic valve surgery 4.8%; mitral valve surgery 8.8%; double or triple valve surgery 9.7%; CABG and valve surgery 7.4%). Of 63 patient-specific and treatment variables, 54 were found to have a significant univariate association with postoperative stroke. Multivariable analysis revealed 10 variables that were independent predictors of stroke: history of cerebrovascular disease, peripheral vascular disease, diabetes, hypertension, previous cardiac surgery, preoperative infection, urgent operation, CPB time more than 2 hours, need for intraoperative hemofiltration, and high transfusion requirement. Beating heart CABG was associated with a lower incidence of stroke in this multivariable analysis.
Conclusions:
Identification of predictors for stroke is important for understanding the pathogenesis of this devastating complication as well as for developing preventative strategies. Although retrospective analyses can be subject to selection bias we believe beating heart CABG is associated with a lower incidence of stroke and may therefore improve patient outcomes.
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