Determinants of stroke after coronary artery bypass grafting

D’Ancona, Giuseppe; Ibarra, J.I. Sáez de; Baillot, Richard; Mathieu, Patrick; Doyle, Daniel; Métras, Jacques; Desaulniers, Denis; Dagenais, François

doi:10.1016/s1010-7940(03)00440-8

Cited by 51 publications

(34 citation statements)

References 17 publications

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“…The reported frequencies range between 1% and 4% in patients undergoing coronary artery bypass grafting (CABG), with the risk nearly doubled in older age. [1][2][3][4][5] Similar rates were found for patients receiving heart valve replacement. 6,7 Cognitive deficits after heart surgery have been observed in 33% to 83% of patients during the first weeks after surgery.…”

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confidence: 70%

Diffusion-Weighted Magnetic Resonance Imaging and Neurobiochemical Markers After Aortic Valve Replacement

Stolz

Gerriets

Kluge

et al. 2004

Stroke

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Background and Purpose-Cardiac surgery carries a high risk of neurological complications; therefore, these patients would be an appropriate target population for neuroprotective strategies. In this study, we evaluated postoperative diffusion-weighted imaging (DWI) as a potential surrogate marker for brain embolism and its relationship to neurobiochemical markers of brain injury. Methods-Of a total of 45 consecutive patients undergoing aortic valve replacement, 37 completed preoperative and postoperative MRI. At the time of the MRI studies, serum S100␤ and neuron-specific enolase concentrations were determined. Preexisting T2 and postoperative DWI lesion volumes were quantified. All patients had a blinded neurological examination before and after operation. Results-New perioperative DWI lesions were present in 14 patients (38%), of whom only 3 developed focal neurological deficits. Eighteen small lesions were found in the white matter or vascular border zones in all but 2 patients with territorial stroke. The appearance of new DWI lesions correlated with age, pre-existing T2 lesion volume, and postoperative S100␤ concentrations on days 2 to 4 after surgery. In a forward stepwise canonical discrimination model, only T2 lesion volume was selected as a relevant variable. Conclusions-The

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confidence: 70%

Diffusion-Weighted Magnetic Resonance Imaging and Neurobiochemical Markers After Aortic Valve Replacement

Stolz

Gerriets

Kluge

et al. 2004

Stroke

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“…This decrease was attributed to hypothermia and hypocarbia. In a study conducted by D'Ancona et al [11], as documented, the carotid artery disease and history of previous stroke can result in CVA through intraoperative or perioperative cerebral hypoperfusion. We have examined other variables, such as pump time, cross-clamp time, perfusion pressure and flow, during coronary bypass surgery among our three groups to find any association with perioperative stroke.…”

Section: Resultsmentioning

confidence: 99%

“…Its etiology is multifactorial, including cerebral embolization from iatrogenic mobilization of atherosclerotic plaques, air/fat embolism, peripheral vascular disease (PVD), hemodynamic fluctuations, cerebral hyperthermia, aortic dissection, particular microemboli, emboli because of aortic arch disease, aortic "crunch" occurring with cross-clamping or cannulation, air and fat emboli [7][8][9][10] and systemic inflammatory reaction [11]. In spite of that, concomitant carotid artery disease may be very important in the etiology of perioperative stroke in patients undergoing CABG.…”

Section: Introductionmentioning

confidence: 99%

The impact of carotid artery disease on outcomes of patients undergoing coronary artery bypass grafting

Abbaszadeh¹

2011

Rev Bras Cir Cardiovasc

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Objective: Although the overall complication rate has been decreased significantly in recent years, stroke is a severe complication after coronary bypass operations. The purpose of this study is to evaluate the influence of carotid artery disease on the results of patients under CABG operation.Methods: In a retrospective cohort study, 1,978 patients under CABG operation were studied in Shariati Hospital between April 2002 and March 2006. The patients who had only valve replacement or non-CABG procedure were excluded from this study. As part of preoperative evaluation, carotid duplex ultrasonography scans were performed. In order to estimate the degree of carotid arteries stenosis, ultrasound imaging measurement and velocity criteria were considered. The patients were classified into three groups: those with no significant stenosis of the internal carotid artery (ICA) (moderate) group A, those with significant stenosis (sever) group B and those with the occluded ICA (critical) group C. Finally, all data were analyzed by SPSS software. Statistical analyses were performed using the following testes; chisquare, Fisher exact and Student's t tests.Results: The distribution of the 1,978 patients undergoing CABG operation were as follows: group A = 1,938, group B = 30, and group C = 10. The results of the evaluations show that perioperative stroke rates were 1.2% (24 patients) in group A, 0.4% (eight patients) in group B and 0.3% (six patients) in group C (P<0.0001). Furthermore, perioperative mortality rates for groups A, B and C were 0.1% (two patients), 0.3% (five patients) and 0.4% (seven patients), respectively (P<0.0001).Conclusion: The stroke and mortality in patients undergoing CABG are increased when ICA occlusion is present. Rev Bras Cir Cardiovasc 2011;26(2):258-63 Descriptors

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Section: Introductionmentioning

confidence: 99%

“…Percentage varies across studies and depends on study design, patient risk proile, operative techniques, and the length of study followup. Although advances in surgical and medical management have occurred across the last 10 years, the risk of stroke after coronary artery bypass grafting (CABG) has not signiicantly declined likely because of the progressive aging of the CABG population [4].The etiology of postoperative stroke is multifactorial. Previous studies showed that the risk factors for postoperative stroke following CABG include age, low left ventricular ejection fraction, unstable angina, atherosclerosis of the ascending aorta, chronic renal failure, chronic obstructive pulmonary disease, calciied aorta, a history of previous stroke, carotid stenosis, duration of cardiopulmonary bypass, peripheral vascular disease, smoke, and diabetes mellitus.…”

mentioning

confidence: 99%

Coronary Artery Bypass and Stroke: Incidence, Etiology, Pathogenesis, and Surgical Strategies to Prevent Neurological Complications

Gennari¹,

Polvani²,

Generali³

et al. 2017

Coronary Artery Bypass Graft Surgery

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Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke. Among the strategies to decrease or eliminate aortic manipulation, there is the use of of-pump coronary artery bypass grafting (CABG) through an aortic "no touch" technique, which reduces signiicantly the stroke rate. However, this of-pump aortic "no touch" technique is not always applicable, and, when saphenous vein and/or free arterial aortocoronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomosis sewing. We aim to analyze the current incidence, etiology, and physiopathology of the neurological complications after coronary artery bypass surgery. We describe the methods and techniques that provide reduction in the occurrence of neurological complications. CABG with multiple clamp technique failed to ind a beter outcome in terms of neuropsychological deicit in the OPCABG group. By the way, patients undergoing CABG with single clamping seems to have beter outcomes, suggesting that the cross-clamping technique used and minimal aortic manipulation could have had a role in reducing neurocognitive impairment. Moreover, surprisingly, CPB seemed to be a neuroprotective factor, and this aspect could be linked to the mild hypothermia used during on-pump surgery.Keywords: coronary artery bypass, stroke, cardiac surgery, aortic cross clamp, neurologic impairment IntroductionIn 1978 the World Health Organization deined a stroke as a focal or global neurologic deicit due to cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours [1].© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Strokes are classiied by etiology into ischemic strokes (85%) and hemorrhagic strokes (15%). Ischemic strokes result from a critical reduction in blood low and are categorized as embolic, thrombotic, hemodynamic, or hypotensive [2]. Cerebrovascular accidents (CVAs) remain one of the most common complications after surgical myocardial revascularization despite the increased quality of treatment. Cerebral injuries are associated with substantial increases in mortality, morbidity, length of hospitalization, and an impaired quality of life [3].Ischemic stroke occurs in 1.5-5.2% of patients. Percentage varies across studies and depends on study design, patient risk proile, operative techniques, and the length of study followup. Although advances in surgical and medical management have occurred across the last 10 years, the risk of stroke after coronary artery bypass grafting (CABG) has not signiicantly declined likely because of the progressive aging of the CABG population [4].The etiology of postoperative stroke is multifactorial. Previous studies showed that the risk factors for postop...

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Determinants of stroke after coronary artery bypass grafting

Cited by 51 publications

References 17 publications

Diffusion-Weighted Magnetic Resonance Imaging and Neurobiochemical Markers After Aortic Valve Replacement

Diffusion-Weighted Magnetic Resonance Imaging and Neurobiochemical Markers After Aortic Valve Replacement

The impact of carotid artery disease on outcomes of patients undergoing coronary artery bypass grafting

Coronary Artery Bypass and Stroke: Incidence, Etiology, Pathogenesis, and Surgical Strategies to Prevent Neurological Complications

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