Stroke after coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Neurology
• Critical Care Medicine

Background:

• Stroke is a significant complication following cardiac surgery, despite advancements in surgical and cardiopulmonary bypass techniques.
• Identifying preoperative and intraoperative risk factors for perioperative stroke is crucial for patient management during coronary artery bypass graft (CABG) surgery.

Purpose of the Study:

• To identify preoperative and intraoperative risk factors associated with perioperative stroke in patients undergoing CABG surgery on cardiopulmonary bypass.
• To analyze the impact of different cardiopulmonary bypass temperature strategies on stroke incidence.

Main Methods:

• A retrospective analysis of 4,380 consecutive patients undergoing isolated CABG on cardiopulmonary bypass between 1992 and 2002.
• Patients were categorized into three cardiopulmonary bypass temperature groups: hypothermic (<31°C), tepid (32-35°C), and normothermic (>36°C).
• Stroke incidence, 30-day mortality, and length of hospital stay were the primary outcome measures.

Main Results:

• The overall stroke incidence was 1.2% (51 patients).
• Patients who experienced stroke were older, more frequently diabetic, hypertensive, had elevated creatinine levels, and a prior history of stroke (p < 0.05).
• Independent predictors for stroke included diabetes (p=0.01), history of stroke (p=0.04), and older age (p=0.05). 30-day mortality was significantly higher in stroke patients (17.6% vs 1.7%).

Conclusions:

• Diabetes, a history of stroke, and advanced age are significant risk factors for stroke after coronary artery bypass surgery.
• The temperature management during cardiopulmonary bypass was not found to be a significant predictor of stroke in this patient cohort.
• These findings underscore the importance of managing modifiable risk factors like diabetes and considering patient history in stroke prevention strategies for CABG patients.