Risk of cardiac surgery in patients with prior stroke

Area of Science:

• Neurology
• Cardiology
• Neurosurgery

Background:

• Ischemic stroke history presents a potential risk factor for patients undergoing open heart surgery (OHS).
• Understanding the impact of prior stroke timing (recent vs. remote) and severity on perioperative outcomes is crucial.

Purpose of the Study:

• To retrospectively evaluate the clinical outcomes of patients with a history of ischemic stroke who underwent OHS.
• To determine the incidence and characteristics of new or worsening neurological deficits post-OHS in this patient cohort.

Main Methods:

• Retrospective analysis of 126 patients with a history of ischemic stroke undergoing OHS.
• Classification of prior strokes based on recency (recent vs. remote) and neurological deficit severity.
• Monitoring for new strokes or worsening of pre-existing deficits during the perioperative period.

Main Results:

• 13.4% of patients experienced new strokes or worsening deficits, with only 3.2% having moderate-severe outcomes.
• No significant difference in new stroke rates was observed between recent and remote stroke groups.
• Recent strokes were more associated with worsening of prior deficits, while remote strokes involved new brain areas; intraoperative hypotension was more frequent in the recent stroke group.

Conclusions:

• The overall risk of new or worsening strokes after OHS in patients with prior ischemic stroke is relatively low.
• Recent stroke history may indicate persistent hemodynamic vulnerability rather than an increased risk of new stroke events.
• Further investigation into hemodynamic management during OHS for patients with recent strokes is warranted.