Related Experiment Video
Updated: Sep 5, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Risk factors for cerebrovascular accident after isolated coronary artery bypass grafting in Veterans
Jessica B LaPiano1,2, Suzanne M Arnott1,3, Michael A Napolitano1,3
1Division of Cardiothoracic Surgery and Heart Center, Washington D. C. Veterans Affairs Medical Center and Heart Center, Washington, District of Columbia, USA.
Insights
Cerebrovascular accident (CVA) after coronary artery bypass grafting (CABG) is linked to cerebrovascular disease, reduced ejection fraction, and longer bypass times. Optimizing these factors may reduce CVA risk in veterans undergoing CABG.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Nephrology
Background:
- Cerebrovascular accident (CVA) following coronary artery bypass grafting (CABG) is a severe complication.
- Patient comorbidities and intraoperative factors significantly influence CVA risk.
- Identifying specific risk factors in veterans undergoing CABG is crucial for improving patient outcomes.
Purpose of the Study:
- To identify independent risk factors for postoperative CVA in a veteran population undergoing isolated CABG.
- To analyze the association between preoperative conditions and intraoperative variables with CVA incidence.
- To provide data for optimizing patient management and reducing CVA risk.
Main Methods:
- Retrospective analysis of isolated CABG cases from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database (2008-2019).
- Inclusion of 28,757 patients with observation of 30-day postoperative outcomes.
- Application of univariate and multivariable logistic regression, with ROC diagnostics for continuous variables.
Main Results:
- The incidence of CVA was 1.1% (310 cases).
- Preoperative cerebrovascular disease was the strongest predictor (aOR=2.29, p<.001).
- Lower ejection fraction (35-39% vs >55%) increased risk (aOR=2.11, p<.001), as did bypass time ≥104 min (aOR=1.55, p<.001). Poor kidney function and prior myocardial infarction were also significant risk factors.
Conclusions:
- The risk of CVA after CABG is multifactorial, involving cardiac, renal, and cerebrovascular systems.
- Preoperative cerebrovascular disease is the most significant risk factor identified.
- Optimizing comorbidities and minimizing time on bypass are key strategies to reduce CVA risk.
Background:
Cerebrovascular accident (CVA) after coronary artery bypass grafting (CABG) is a devastating complication. Patient comorbidities and intraoperative elements contribute to the risk of CVA. The aim of this study is to identify risk factors for CVA in Veterans undergoing CABG.
Methods:
Veterans undergoing isolated CABG from 2008 to 2019 were retrospectively identified using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Thirty-day postoperative outcomes were observed. Univariate analysis followed by multivariable logistic regression identified independent risk factors for postoperative CVA. Receiver operating characteristic diagnostics identified optimal inflection points between continuous risk factors and odds of CVA.
Results:
Twenty-eight thousand seven hundred fifty-seven patients met inclusion criteria. Incidence of CVA was 1.1% (310 cases). In multivariate analysis, preoperative cerebrovascular disease had the strongest association with postoperative CVA (adjusted odds ratio = 2.29; p < .001). There was an inverse relationship between CVA incidence and ejection fraction (EF), with EF of 35%-39% conferring a 2.11 times higher risk compared to EF >55% (p < .001). CVA incidence was not different in on-pump versus off-pump cases; however, after 104 min or more on bypass patients had a 55% greater adjusted odds of CVA (p < .001). Other risk factors included poor kidney function, prior myocardial infarction, and intra-aortic balloon pump use.
Conclusion:
The risk of CVA after CABG is multifactorial and involves multiple organ systems, including cardiac disease, poor renal function, and cerebrovascular disease, which was the strongest contributing risk factor. Optimization of these comorbidities and time on bypass may help improve clinical outcomes and lower the risk of this devastating complication.
More Related Videos
07:02A Rabbit Venous Interposition Model Mimicking Revascularization Surgery using Vein Grafts to Assess Intimal Hyperplasia under Arterial Blood Pressure
Published on: May 15, 2020
09:04Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction