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Predictors of stroke after cardiac surgery
A C Cernaianu1, T V Vassilidze, D R Flum
1Department of Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden 08103, USA.
Insights
Cerebrovascular accidents (CVAs) occurred in 1.8% of cardiac surgery patients. Severe aortic atherosclerosis and longer cardiopulmonary bypass times were key predictors of post-operative stroke, highlighting the need for risk factor identification.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Cerebrovascular accidents (CVAs) are a significant complication following cardiac surgery.
- Identifying predictors of CVA is crucial for improving patient outcomes.
Purpose of the Study:
- To retrospectively review patients undergoing cardiac surgery to identify risk factors for intraoperative or postoperative cerebrovascular accidents (CVAs).
- To determine the incidence and predictors of CVA in patients with acquired heart disease.
Main Methods:
- Retrospective review of demographic data, atherosclerosis risk factors, medical history, and intraoperative findings in 2,455 cardiac surgery patients.
- Analysis of CVA rates in relation to specific surgical procedures and intraoperative findings, including aortic arch atherosclerosis.
Main Results:
- The overall CVA rate was 1.8% (44 of 2,455 patients).
- Highest CVA rate (18.2%) was observed in patients undergoing simultaneous myocardial revascularization and carotid endarterectomy.
- Severe aortic arch atherosclerosis at the cannulation site (43.2%) and longer cardiopulmonary bypass (CPB) and aortic cross-clamping times were significantly associated with CVA.
- Hypertension was an independent risk factor for postoperative CVA.
Conclusions:
- Severe aortic arch atherosclerosis and prolonged CPB times are significant predictors of post-cardiopulmonary bypass CVA.
- Identifying high-risk patients preoperatively is essential for reducing CVA-related morbidity and mortality.
- Simultaneous myocardial revascularization and carotid endarterectomy represent a high-risk subgroup for neurological events.
Abstract:
From January 1, 1988 to September 30, 1993, 44 of 2,455 patients undergoing cardiac surgery for acquired heart disease at our institution sustained an intraoperative or postoperative cerebrovascular accident (CVA). Demographic data, atherosclerosis risk factors, past medical history, cardiac catheterization reports, and intraoperative findings were retrospectively reviewed. The highest rate of CVA was in the sub-group of patients undergoing simultaneous myocardial revascularization and carotid endarterectomy (18.2%). The lowest rate was in a group of patients who underwent aortic valve replacement (0.9%). Severe aortic arch atherosclerosis with the presence of atheromatous material or calcinosis at the cannulation site was identified intraoperatively in 43.2% of patients with neurological complications and in 5% of the group without CVA (x2 = 18.1, p = 0.0001). Of 44 patients with CVA, 13.6% had a history of preoperative completed stroke. CPB time was 90.1 +/- 4.9 min vs. 71.6 +/- 3.7 min (p = 0.004), and aortic cross-clamping time was 54.5 +/- 3.2 min compared to 39.8 +/- 2.7 min (p = 0.001) in groups with and without postoperative stroke, respectively. Hypertension was an independent risk factor of postoperative CVA (x2 = 9.5, p = 0.02), but age was not. Neurological complications correlated with high operative mortality (38.6%) and prolonged postoperative hospital stays (35.1 +/- 5.3). These data describe predictors for the development of post-cardiopulmonary bypass CVA and identify a high-risk subgroup for neurological events. The preoperative recognition of risk factors is an essential step toward the reduction of morbidity and mortality.