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Risk Factors for Stroke Development After Thoracic Aortic Surgery

Akram M Zaaqoq1, Jason Chang2, Sri Raksha Pothapragada3

  • 1Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC.

Journal of Cardiothoracic and Vascular Anesthesia
|September 16, 2023
PubMed

Insights

Intraoperative factors like lower hemoglobin, longer cardiopulmonary bypass, and hypothermia increase stroke risk after thoracic aortic surgery. Identifying these risks can help prevent this serious complication.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Stroke is a significant complication following thoracic aortic surgery, associated with adverse patient outcomes.
  • Understanding intraoperative risk factors is crucial for developing preventative strategies.

Purpose of the Study:

  • To identify and characterize intraoperative risk factors associated with postoperative stroke development in patients undergoing thoracic aortic surgery.

Main Methods:

  • Retrospective analysis of 704 patients who underwent thoracic aortic repair between January 2017 and December 2021.
  • Comparison of intraoperative variables between patients who developed postoperative stroke and those who did not.

Main Results:

  • The incidence of postoperative stroke was higher in type A aortic dissections (12.3%) compared to ascending aortic aneurysms (4.5%).
  • Patients experiencing stroke had significantly lower intraoperative hemoglobin, longer cardiopulmonary bypass times, increased use of deep hypothermic circulatory arrest, and lower postoperative temperatures.

Conclusions:

  • Lower intraoperative hemoglobin, prolonged cardiopulmonary bypass, deep hypothermic circulatory arrest, and postoperative hypothermia are identified as potential risk factors for stroke.
  • These findings underscore the importance of intraoperative management in mitigating stroke risk in thoracic aortic surgery patients.
  • Further research is warranted to establish definitive preventative measures for this complication.
Abstract

Keywords:
cerebrovascular accidentsstrokethoracic aortic aneurysmtype A aortic dissection

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