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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
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Published on: March 27, 2018

Determinants of stroke after coronary artery bypass grafting

Giuseppe D'Ancona1, José Ignacio Saez de Ibarra, Richard Baillot

  • 1Department of Cardiovascular Surgery, Laval Hospital, Quebec Heart Institute, 2725 Chemin Ste-Foy, Sainte-Foy, QC, Canada G1V 4G5. rgea@hotmail.com

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 23, 2003
PubMed

Insights

Cerebrovascular accidents (CVA) after coronary artery bypass grafting (CABG) are linked to patient comorbidities, not surgical factors. Prevention strategies should focus on preoperative risk assessment and patient selection for CABG.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Critical Care Medicine

Background:

  • Cerebrovascular accidents (CVA) are serious complications following coronary artery bypass grafting (CABG).
  • The determinants for CVA after CABG are not well-defined, necessitating further investigation for effective prevention strategies.

Purpose of the Study:

  • To identify the key determinants contributing to the occurrence of cerebrovascular accidents (CVA) in patients undergoing coronary artery bypass grafting (CABG).

Main Methods:

  • A retrospective analysis of 9,916 patients who underwent CABG between January 1992 and June 2002.
  • Prospective data collection followed by univariate and multivariate statistical analyses to identify risk factors for perioperative CVA.

Main Results:

  • 2.1% of patients (208) experienced perioperative CVA, with significantly higher mortality (18.6%) compared to controls (2.6%).
  • Preoperative risk factors identified include advanced age, low left ventricular ejection fraction (LVEF < 30%), diabetes mellitus (DM), chronic renal failure (CRF), peripheral vascular disease (PVD), previous CVA, and redo surgery.
  • Perioperative determinants included intra-aortic balloon pump use and higher transfusion rates, while longer cardiopulmonary bypass (CPB) and myocardial ischemia times were also noted.

Conclusions:

  • Cerebrovascular accident (CVA) occurrence after CABG is primarily associated with preoperative patient comorbidities rather than intraoperative surgical variables.
  • Prevention efforts should prioritize preoperative risk stratification and tailored strategies for high-risk patients before CABG indication.
  • Further research into optimizing patient selection and management is crucial for reducing CVA rates post-CABG.
Abstract

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