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Published on: September 22, 2017
Cardiopulmonary bypass in patients with previously completed stroke
A C Beall1, J W Jones, G A Guinn
1Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Patients with prior stroke and neurological deficits may not face higher risks for neurological complications during cardiac surgery. This retrospective study found low complication rates in such patients undergoing cardiopulmonary bypass.
Area of Science:
- Cardiology
- Neurology
- Neurosurgery
Background:
- Patients with neurological deficits post-stroke are often considered at higher risk for complications during cardiac surgery.
- Cardiac operations requiring cardiopulmonary bypass (CPB) carry inherent neurological risks.
Purpose of the Study:
- To evaluate the actual risk of neurological complications in patients with prior completed stroke and neurological residua undergoing cardiac operations with CPB.
- To challenge the assumption of increased risk in this patient population.
Main Methods:
- Retrospective review of 1,163 consecutive patients undergoing cardiac operations with CPB.
- Analysis of a subgroup of 43 patients with completed stroke and neurological residua, excluding those with significant carotid artery disease.
Main Results:
- Only 1 out of 43 patients (2.3%) experienced new neurological symptoms post-operation.
- The overall mortality in the subgroup was 1 death (2.3%) due to pulmonary embolism.
- Procedures included coronary artery bypass grafting and valve replacements.
Conclusions:
- The assumption that patients with prior stroke and neurological deficits are at increased risk for neurological complications during cardiac surgery requiring CPB may not be valid.
- These findings suggest that carefully selected patients with prior stroke can undergo cardiac operations with CPB with relatively low neurological complication rates.
Abstract:
It has been assumed that patients with neurological residua after a completed stroke are at increased risk of neurological complications associated with cardiac operations requiring cardiopulmonary bypass. To evaluate these assumptions, we reviewed retrospectively 1,163 consecutive patients undergoing cardiac operations with cardiopulmonary bypass. Among these 1,163 patients were 43 patients having a previously completed stroke with neurological residua, but without clinically significant extracranial carotid artery disease. Forty-one underwent coronary artery bypass grafting; of these, 1 required concomitant aortic valve replacement, 1 had mitral valve replacement, and 1 had aortic valve replacement. There was one death in this group of 43 patients, due to massive pulmonary embolism. Only 1 of these 43 patients experienced new neurological symptoms after operation, which would appear to indicate that patients with a previous, completed stroke may not be at increased risk of neurological complications from cardiac operations requiring cardiopulmonary bypass.
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