Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis

Abstract

Background Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterise the incidence of stroke and analyse the impact of stroke on patient outcomes and survival. Methods A retrospective analysis was performed of patients with a CT-confirmed stroke diagnosis between 01/01/2015 and 31/03/2019 at a single centre. 2:1 propensity matching was performed to identify a control population. Results Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging 0.85% for CABG to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or TIA. Compared to the comparison group, patients experiencing post-operative stroke had a significantly prolonged period of ICU admission (8.0 vs 1.1 days p<0.001) and hospital length of stay (12.94 vs 8.0 days p<0.001). Patient survival was also inferior. In-hospital mortality was almost 3 times as high (17.0% vs 5.9%; p<0.001). Longer-term survival was also inferior on Kaplan-Meier estimation (p<0.001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group. Conclusion Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. The potential to reduce morbidity and mortality with the emergence of mechanical thrombectomy, demonstrates the need for clear links between cardiothoracic and stroke teams to support individuals affected by perioperative stroke.

Novel use of the Sentinel cerebral protection device during thrombosed septal occluder explant and Atriclip appendage closure

“…(B) Two-dimensional TEE images depicting mal-apposition of the septal closure device (white arrow) and deviceassociated thrombus (blue arrow) of these techniques, the incidence of perioperative strokes remains about 0.85% in coronary artery bypass grafting (CABG) and 8.14% in major aortic surgery. 1 The majority of early perioperative strokes are embolic in nature. Cerebral protection devices are designed to capture emboli dislodged during manipulation of the calcified vasculature.…”

“…Some techniques used include near‐infrared spectroscopy to monitor brain oxygenation intraoperatively, TEE to scan the aorta for atheroma for surgical planning, arterial line filters incorporated into the CBP circuit, strict glycemic control, and hypothermia, to reduce cerebral metabolism 2 . Despite the application of these techniques, the incidence of perioperative strokes remains about 0.85% in coronary artery bypass grafting (CABG) and 8.14% in major aortic surgery 1 …”

“…Stroke remains a devastating complication of cardiac surgery. Perioperative stroke incidence following cardiac surgery ranges from 0.8% to 5.2% 1 . The Food and Drug Administration (FDA) recently approved use of the Sentinel cerebral protection device (SCPD) during transcatheter aortic valve replacement (TAVR) to prevent emboli from causing potentially irreversible neurological damage.…”

“…DISCUSSIONPerioperative stroke extends hospital length of stay (LOS) and increases morbidity and mortality for patients undergoing cardiac surgery. The estimated additional cost per patient attributed to the prolongation of intensive care unit (ICU) and non-ICU LOS is approximately $14,000 1. This estimate does not account for the costs associated with decrease in quality of life, additional outpatient evaluation, medications, and rehabilitation.Neuroprotective strategies to reduce the incidence of perioperative strokes have been assessed in the past, but results have remained discrepant.…”

“…There is also malapposition of the device with a resultant small septal defect (white arrow). (B) Two-dimensional TEE images depicting mal-apposition of the septal closure device (white arrow) and deviceassociated thrombus (blue arrow) of these techniques, the incidence of perioperative strokes remains about 0.85% in coronary artery bypass grafting (CABG) and 8.14% in major aortic surgery 1. The majority of early perioperative strokes are embolic in nature.…”