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Intraoperative and postoperative variables associated with strokes following cardiac surgery

Donald S Likosky1, Louis R Caplan, Ronald M Weintraub

  • 1Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire 03756, USA. donald.s.likosky@dartmouth.edu

The Heart Surgery Forum
|September 30, 2004
PubMed

Insights

Postoperative atrial fibrillation and longer cardiopulmonary bypass times increase stroke risk after coronary artery bypass grafting (CABG) surgery. Managing these factors may improve patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Critical Care Medicine

Background:

  • Stroke is a serious complication following coronary artery bypass grafting (CABG).
  • Previous research identified stroke mechanisms post-CABG.
  • This study quantifies associations between perioperative factors and stroke mechanisms.

Purpose of the Study:

  • To determine the association between intraoperative and postoperative variables and stroke mechanisms.
  • To adjust for patient and disease characteristics in the analysis.
  • To identify modifiable risk factors for stroke after CABG.

Main Methods:

  • Prospective study of 13,897 patients undergoing isolated CABG (1992-2000).
  • Collected data on patient/disease characteristics, perioperative care, and outcomes.
  • Classified strokes (embolic, hypoperfusion, mixed) and calculated odds ratios (OR).

Main Results:

  • Longer cardiopulmonary bypass time (>2 hours) associated with embolic strokes (OR 1.5).
  • Postoperative atrial fibrillation linked to embolic (OR 2.4), hypoperfusion (OR 5.4), and mixed strokes (OR 1.7).
  • Increased cardiopulmonary bypass duration strongly predicted hypoperfusion strokes (OR 6.4).

Conclusions:

  • Postoperative atrial fibrillation and prolonged cardiopulmonary bypass are significant predictors of stroke mechanisms.
  • These factors remain significant after adjusting for preoperative characteristics.
  • Preventing/managing atrial fibrillation and minimizing extracorporeal circulation duration may reduce stroke risk.
Abstract

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