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DOI: 10.1055/s-0034-1371909
Stroke after Coronary Artery Surgery: A Single Center Report
Publication History
Publication Date:
28 August 2014 (online)
Abstract
Stroke or cerebrovascular accident (CVA) is a devastating complication of coronary surgery. In this report, the incidence, and correlates of CVA following isolated coronary artery bypass grafting (CABG) surgery were evaluated. Data were collected retrospectively. Between 2006 and 2009, 855 patients underwent isolated CABG surgery. CVA was defined as any new neurological deficit lasting more than 24 hours. Univariate and multivariate analyses were utilized as appropriate. The incidence of CVA was 1.4% (n = 12). Age, previous CVA, and emergency surgery were correlated by univariate analysis. Multivariate analysis revealed age, previous CVA, and chronic renal impairment as predictors of CVA. Ten (83.3%) of the 12 patients were diagnosed to have CVA in the first 24 hours. Length of hospital stay was 20.9 ± 20.34 days for CVA patients and 9.2 ± 5.17 days for non-CVA patients (p ≤ 0.001). There were 4 (33.3%) deaths in CVA group and 27 (3.2%) for non-CVA patients (p = 0.001). Postoperative CVA is a major contributor to mortality, prolonged hospitalization, and other adverse postoperative complications. Further studies are needed to develop better strategies to minimize the occurrence of CVA among patients undergoing CABG.
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References
- 1 Gilman S. Cerebral disorders after open-heart operations. N Engl J Med 1965; 272: 489-498
- 2 Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH. Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2008; 85 (3) 862-870
- 3 Bucerius J, Gummert JF, Borger MA , et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 2003; 75 (2) 472-478
- 4 John R, Choudhri AF, Weinberg AD , et al. Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg 2000; 69 (1) 30-35 , discussion 35–36
- 5 Mickleborough LL, Walker PM, Takagi Y, Ohashi M, Ivanov J, Tamariz M. Risk factors for stroke in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 1996; 112 (5) 1250-1258 , discussion 1258–1259
- 6 Likosky DS, Marrin CA, Caplan LR , et al; Northern New England Cardiovascular Disease Study Group. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke 2003; 34 (12) 2830-2834
- 7 Ricotta JJ, Faggioli GL, Castilone A, Hassett JM. Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group. J Vasc Surg 1995; 21 (2) 359-363 , discussion 364
- 8 McKhann GM, Goldsborough MA, Borowicz Jr LM , et al. Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg 1997; 63 (2) 516-521
- 9 Libman RB, Wirkowski E, Neystat M, Barr W, Gelb S, Graver M. Stroke associated with cardiac surgery. Determinants, timing, and stroke subtypes. Arch Neurol 1997; 54 (1) 83-87
- 10 D'Ancona G, Saez de Ibarra JI, Baillot R , et al. Determinants of stroke after coronary artery bypass grafting. Eur J Cardiothorac Surg 2003; 24 (4) 552-556
- 11 Oliveira DC, Ferro CR, Oliveira JB , et al. Risk factors for stroke after coronary artery bypass grafting. Arq Bras Cardiol 2008; 91 (4) 213-216 , 234–237
- 12 Craver JM, Bufkin BL, Weintraub WS, Guyton RA. Neurologic events after coronary bypass grafting: further observations with warm cardioplegia. Ann Thorac Surg 1995; 59 (6) 1429-1433 , discussion 1433–1434
- 13 van Wermeskerken GK, Lardenoye JW, Hill SE , et al. Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome. Ann Thorac Surg 2000; 69 (4) 1077-1083
- 14 Stamou SC, Hill PC, Dangas G , et al. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke 2001; 32 (7) 1508-1513
- 15 Calafiore AM, Di Mauro M, Teodori G , et al. Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization. Ann Thorac Surg 2002; 73 (5) 1387-1393
- 16 Hogue Jr CW, Murphy SF, Schechtman KB, Dávila-Román VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation 1999; 100 (6) 642-647
- 17 Roach GW, Kanchuger M, Mangano CM , et al; Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 1996; 335 (25) 1857-1863
- 18 Charlesworth DC, Likosky DS, Marrin CAS , et al; Northern New England Cardiovascular Disease Study Group. Development and validation of a prediction model for strokes after coronary artery bypass grafting. Ann Thorac Surg 2003; 76 (2) 436-443
- 19 Toumpoulis IK, Anagnostopoulos CE, Chamogeorgakis TP , et al. Impact of early and delayed stroke on in-hospital and long-term mortality after isolated coronary artery bypass grafting. Am J Cardiol 2008; 102 (4) 411-417
- 20 Antunes PE, de Oliveira JF, Antunes MJ. Predictors of cerebrovascular events in patients subjected to isolated coronary surgery. The importance of aortic cross-clamping. Eur J Cardiothorac Surg 2003; 23 (3) 328-333
- 21 Mikkola R, Gunn J, Heikkinen J , et al. Use of blood products and risk of stroke after coronary artery bypass surgery. Blood Transfus 2012; 10 (4) 490-501
- 22 D'Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg 1996; 62 (6) 1714-1723
- 23 Redmond JM, Greene PS, Goldsborough MA , et al. Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg 1996; 61 (1) 42-47
- 24 Puskas JD, Winston AD, Wright CE , et al. Stroke after coronary artery operation: incidence, correlates, outcome, and cost. Ann Thorac Surg 2000; 69 (4) 1053-1056
- 25 Sotaniemi KA. Long-term neurologic outcome after cardiac operation. Ann Thorac Surg 1995; 59 (5) 1336-1339
- 26 Cernaianu AC, Vassilidze TV, Flum DR , et al. Predictors of stroke after cardiac surgery. J Card Surg 1995; 10 (4 Pt 1) 334-339
- 27 Blauth CI, Cosgrove DM, Webb BW , et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 1992; 103 (6) 1104-1111 , discussion 1111–1112
- 28 Biancari F, Yli-Pyky S. Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2011; 40 (5) 1236-1240
- 29 Biancari F, Rimpiläinen R. Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart 2009; 95 (12) 964-969
- 30 Carrascal Y, Guerrero AL. Neurological damage related to cardiac surgery: pathophysiology, diagnostic tools and prevention strategies. Using actual knowledge for planning the future. Neurologist 2010; 16 (3) 152-164
- 31 Nissinen J, Biancari F, Wistbacka JO , et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion 2009; 24 (5) 297-305
- 32 Haugen O, Farstad M, Myklebust R, Kvalheim V, Hammersborg S, Husby P. Low perfusion pressure during CPB may induce cerebral metabolic and ultrastructural changes. Scand Cardiovasc J 2007; 41 (5) 331-338