Perioperative Stroke in Coronary Artery Bypass Patients

Loponen, Pertti; Taskinen, Panu; Laakkonen, Eero; Nissinen, Juha; Luther, M; Jo, Wistbacka

doi:10.1177/145749690309200207

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…The estimate of stroke in our study population was approximately 5%; which is much higher than the 2% estimate for stroke reported in the regular CABG population [56]. This could be attributed to PAD being an independent risk factor for stroke development following CABG, thereby posing a generally higher risk for cerebrovascular accidents in our patient population [21,57]. Nonetheless, we could not establish a link between the applied grafting method and stroke.…”

Section: Discussioncontrasting

confidence: 71%

The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

Micali

Bonacchi

Weigel

et al. 2020

J Cardiothorac Surg

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Background Patients with a history of peripheral arterial disease (PAD) undergoing coronary artery bypass grafting (CABG) exhibit higher rates of complications. There are conflicting data on the survival benefits for bilateral thoracic artery (BITA) grafting compared with left internal thoracic artery (LITA) CABG in patients with PAD. The aim of the study was to explore the influence of the use of BITA grafts vs. LITA for CABG on post-operative acute lower limb ischemia (ALLI) and main post-operative complications in patients with concomitant PAD. Methods We used a propensity-score (PS) based analysis to compare outcomes between the two surgical procedures, BITA and LITA. The inverse probability of treatment weighting PS technique was applied to adjust for pre- and intra-operative confounders, and to get optimal balancing of the pre-operative data. The primary outcome was the estimate of postoperative ALLI. Secondary outcomes included overall death and death of cardiac causes within 30 days of surgery, stroke and acute kidney disease (AKD). Results The study population consisted of 1961 patients. The LITA procedure was performed in 1768 patients whereas 193 patients underwent a BITA technique. The estimate of ALLI was 14% higher in the BITA compared to the LITA (p < 0.001) group. Thirty-day mortality, cardiac death, occurrence of stroke and AKI did not differ significantly between the groups. Conclusions The use of both ITAs led to a significant increase in ALLI. This result was most likely caused by the complete disruption of the ITA collateral providing additional blood supply to the lower extremities. Based on our data, BITA should be used with extreme caution in PAD patients. Further research on this topic is necessary to confirm our findings.

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Section: Discussioncontrasting

confidence: 71%

The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

Micali

Bonacchi

Weigel

et al. 2020

J Cardiothorac Surg

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“…Early mortality after surgery is estimated at 4%–5% (3, 4), and of the surviving patients up to 7% never return to an independent lifestyle (3). In coronary artery bypass surgery (no circulatory arrest), the risk of perioperative stroke is 2.6%, which increases morbidity and mortality (5).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery

et al. 2018

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After hypothermic circulatory arrest, patients undergoing surgery of the thoracic aorta achieve a similar long-term life expectancy and health-related quality of life as do patients undergoing coronary surgery without hypothermic circulatory arrest, and a health-related quality of life similar to the national reference population with chronic illnesses. These results justify operative treatment in this high-risk patient population.

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“…Stroke frequency is reported to be 1.3-4.3% after coronary-artery surgery, more common in patients with additional risk factors such as diabetes mellitus, arterial hypertension, peripheral vascular disease, history of cerebrovascular disease, number of aortic anastomoses, and chronic obstructive pulmonary disease 85,86 .…”

Section: Stroke and Microembolimentioning

confidence: 99%

The coagulopathy of cardiopulmonary bypass

Besser

Klein

2010

Critical Reviews in Clinical Laboratory Sciences

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There have been numerous publications on the coagulopathy of cardiopulmonary bypass (CPB). This review provides an introduction to the history and main components of current CPB circuits and summarizes the current knowledge of pathogenesis, prevention, and treatment of the CPB coagulopathy. It encompasses an overview of intra- and postoperative monitoring of coagulation with special emphasis on the near-patient testing, its main complications, and the transfusion support, while taking into account the major changes in the technology used and supportive care provided since its inception.

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Perioperative Stroke in Coronary Artery Bypass Patients

Cited by 5 publications

References 15 publications

The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

The use of both internal thoracic arteries for coronary revascularization increases the estimate of post-operative lower limb ischemia in patients with peripheral artery disease

Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery

The coagulopathy of cardiopulmonary bypass

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