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Disminución de la incidencia de ictus durante la cirugía valvular
M A Borger1, J Ivanov, R D Weisel
1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
Circulation
|December 16, 1998
Resumen
La incidencia de ictus durante la cirugía valvular disminuyó durante 15 años, a pesar del aumento de los factores de riesgo. Los predictores clave incluyen endocarditis, edad avanzada y procedimientos urgentes, lo que sugiere causas como embolia y shock.
Área de la Ciencia:
- Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
- Neurología Neurología.
- Salud Pública La salud pública.
Sus antecedentes:
- El accidente cerebrovascular después de la cirugía valvular sigue siendo incompletamente entendido.
- La identificación de los predictores y mecanismos del accidente cerebrovascular es crucial para los resultados de los pacientes.
Objetivo del estudio:
- Examinar la incidencia, los predictores y los mecanismos del accidente cerebrovascular durante los procedimientos valvulares.
- Para analizar las tendencias del accidente cerebrovascular durante un período de 15 años.
Principales métodos:
- Revisión retrospectiva de los datos recopilados prospectivamente de 5954 pacientes (1982-1996).
- Accidente cerebrovascular definido por un déficit neurológico persistente, a menudo confirmado por imágenes de TC.
- Regresión logística multivariable utilizada para identificar predictores independientes.
Principales resultados:
- La incidencia de accidentes cerebrovasculares disminuyó desde el 3,8% (1982-1986) al 2,6% (1992-1996).
- Predictores independientes: endocarditis, edad >74 años, período de operación anterior, tiempo de urgencia, derivación coronaria concomitante y reoperación.
- Prevalencia creciente de pacientes mayores, procedimientos urgentes y cirugía de derivación notada en los últimos años.
Conclusiones:
- La incidencia de accidentes cerebrovasculares durante la cirugía valvular ha disminuido con el tiempo.
- A pesar del aumento de los factores de riesgo, una mejor gestión o técnicas quirúrgicas pueden explicar la disminución.
- Se identificaron las principales causas del accidente cerebrovascular: embolia aterosclerótica, shock y embolia séptica.
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