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Stroke after cardiac surgery--hemispheric distribution and survival
Magnus Hedberg1, Karl Gunnar Engström
1Department of Surgical and Perioperative Science, Heart Center, Cardiothoracic Division, Umeå University, Umeå, Sweden. magnus.hedberg@karolinska.se
Scandinavian Cardiovascular Journal : SCJ
|October 6, 2012
Summary
Early stroke after cardiac surgery predominantly affects the right hemisphere, suggesting specific embolic routes. Delayed stroke shows no hemispheric preference, impacting survival differently.
Area of Science:
- Neurology
- Cardiology
- Neurosurgery
Background:
- Stroke is a significant complication following cardiac surgery.
- Understanding the hemispheric distribution of stroke lesions can elucidate embolic pathways.
Purpose of the Study:
- To analyze the hemispheric distribution of early and delayed stroke lesions after cardiac surgery.
- To identify predictors of stroke laterality and their impact on survival.
Main Methods:
- Retrospective analysis of 10,809 patients undergoing cardiac surgery.
- Evaluation of computed tomography (CT) findings and clinical symptoms to determine lesion laterality.
- Logistic regression and Kaplan-Meier statistics were used for analysis.
Main Results:
- Early stroke showed a right hemisphere predominance (P = 0.009), while delayed stroke had a uniform distribution.
- Tranexamic acid use was associated with bilateral stroke and right-hemispheric stroke.
- Bilateral lesions significantly worsened survival (P < 0.001), unlike unilateral lesions.
Conclusions:
- Early stroke after cardiac surgery exhibits a distinct right-hemispheric preference, unlike delayed stroke.
- This right-sided preponderance suggests embolic events originating from the brachiocephalic trunk.
- Stroke laterality and bilaterality are critical factors influencing patient outcomes and survival post-cardiac surgery.
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