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Stroke associated with cardiac surgery. Determinants, timing, and stroke subtypes
R B Libman1, E Wirkowski, M Neystat
1Department of Neurology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY, USA.
Archives of Neurology
|January 1, 1996
Summary
Postoperative strokes after cardiac surgery are linked to older age, prior transient ischemic attacks, and heart failure. Longer bypass pump times also increase stroke risk, with many strokes occurring days after surgery.
Area of Science:
- Neurology
- Cardiology
- Surgical Outcomes
Background:
- Cardiac surgery carries a risk of postoperative stroke.
- Understanding the characteristics and predictors of these strokes is crucial for patient management.
Purpose of the Study:
- To investigate the nature and risk factors of strokes occurring after cardiac surgery.
Main Methods:
- Retrospective review of 2211 patients undergoing cardiac surgery between 1990 and 1995.
- Univariate and multivariate logistic regression analyses were performed to identify stroke predictors.
Main Results:
- 44 patients (2%) experienced postoperative strokes.
- Significant predictors included congestive heart failure (OR, 6.8) and transient ischemic attack (OR, 1.2).
- Longer cardiopulmonary bypass times (>120 minutes) were also associated with increased stroke risk (OR, 1.40).
Conclusions:
- Strokes can be delayed post-cardiac surgery, potentially due to embolism or hypercoagulable states.
- A notable proportion of strokes present as lacunar syndromes or small-deep infarcts.
- Identifying high-risk patients for perioperative stroke requires further understanding of risk factors, timing, and subtypes.