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Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery

Louise Y Sun1, Amy M Chung, Michael E Farkouh

  • 1From the Division of Cardiac Anesthesiology (L.Y.S., A.M.C., M.B.) the Division of Cardiac Surgery (M.R.) University of Ottawa Heart Institute, Ottawa, Ontario, Canada; the School of Epidemiology and Public Health (L.Y.S.) University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada (L.Y.S.) Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (M.E.F.) the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada (M.E.F.) the Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada (S.v.D.) the Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, New York (J.W.).

Anesthesiology
|June 12, 2018
PubMed

Insights

Intraoperative hypotension during cardiac surgery increases stroke risk. Maintaining adequate mean arterial pressure may help prevent postoperative strokes in these patients.

Area of Science:

  • Cardiology
  • Neurosurgery
  • Anesthesiology

Background:

  • Stroke is a significant complication following cardiac surgery, leading to disability and mortality.
  • Identifying modifiable risk factors for perioperative stroke is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the association between the severity and duration of intraoperative hypotension and the incidence of postoperative stroke in patients undergoing cardiac surgery.

Main Methods:

  • A retrospective cohort study analyzed 7,457 adult patients undergoing cardiac surgery with cardiopulmonary bypass.
  • Intraoperative hypotension was defined by minutes with mean arterial pressure (MAP) below specific thresholds (<55, 55-64, 65-74 mmHg).
  • Logistic regression with propensity score adjustment examined the association between hypotension and postoperative ischemic stroke.

Main Results:

  • Postoperative stroke occurred in 1.5% of patients (111/7,457).
  • Sustained MAP < 64 mmHg during cardiopulmonary bypass was strongly associated with increased stroke risk.
  • Older age, hypertension, combined surgery, emergent status, prolonged bypass, and new-onset atrial fibrillation were also linked to stroke.

Conclusions:

  • Intraoperative hypotension is a potentially modifiable risk factor for perioperative stroke.
  • Targeting mean arterial pressure during cardiopulmonary bypass may be a key strategy to reduce stroke incidence.
Abstract

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