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Predictors and Outcomes of Ischemic Stroke After Cardiac Surgery
Ibrahim Sultan1, Valentino Bianco2, Arman Kilic1
1Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Stroke after cardiac surgery is linked to worse survival, especially with large vessel occlusion. Early intervention showed no survival benefit in this patient group.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Stroke is a significant complication following cardiac surgery, contributing to increased morbidity and mortality.
- Limited data exists on the specific outcomes for patients experiencing large vessel occlusion (LVO) post-cardiac surgery.
Purpose of the Study:
- To investigate the incidence and outcomes of postoperative stroke, with a focus on large vessel occlusion, in patients undergoing cardiac surgery.
- To identify predictors of stroke and operative mortality in this patient population.
Main Methods:
- A review of 10,250 patients undergoing cardiac surgery between 2010 and 2017 from a prospectively maintained database.
- Identification of patients with postoperative ischemic stroke and subsequent analysis of those with large vessel occlusion.
Main Results:
- Postoperative stroke occurred in 2.16% of patients; 24% of these strokes involved large vessel occlusion.
- Patients with postoperative stroke were older, more likely female, and had higher predicted mortality and longer hospital stays.
- Stroke with large vessel occlusion was associated with significantly worse 1-year survival (54.72% vs 75%).
Conclusions:
- Postoperative stroke, particularly large vessel occlusion, is a severe complication of cardiac surgery associated with poorer survival.
- While early intervention did not demonstrate a survival advantage, further research into optimal management strategies for LVO post-cardiac surgery is warranted.
Background:
Stroke is a major complication after cardiac surgery causing increased morbidity and mortality. There are limited data on outcomes of patients with large vessel occlusion after cardiac surgery.
Methods:
Patients who underwent index cardiac surgeries as defined by The Society of Thoracic Surgeons (STS) from 2010 to 2017 were reviewed from a prospectively maintained database. All patients with neurologic deficits were identified, and only patients with ischemic strokes were included.
Results:
A total of 10,250 patients underwent cardiac surgical procedures. Postoperative stroke with neurologic deficits occurred in 221 patients (2.16%). Of these, 53 patients (24%) had large vessel occlusion. Patients who had a postoperative stroke were older and more likely to be female. These patients had higher STS predicted mortality and longer bypass time, cross-clamp time, total intensive care unit stay, and total hospital stay. Operative mortality was significantly higher for patients who had postoperative stroke (14.93% vs 2.15%, P < .001). Kaplan-Meier survival estimates demonstrated worse survival for the large vessel occlusion cohort at 1 year (54.72% vs 75%, P = .002). Predictors of stroke included increasing age, known cerebrovascular disease, diabetes mellitus, and emergent operative status. The most significant predictors of operative mortality included emergent operative status and New York Heart Association stage IV heart failure. There was no difference in 30-day, 1-year, and 5-year mortality between the intervention group and the medically managed patients in the large vessel occlusion cohort.
Conclusions:
Stroke is a devastating complication after cardiac surgery that increases operative morbidity and mortality. Stroke with large vessel occlusion was associated with worse survival. However, early intervention did not impart a survival benefit.
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