Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta

Abstract

Patients with atheromatosis in the ascending aorta had an 8.7% incidence of postoperative stroke, in spite of minor surgical modifications. The risk depended on the presence, location and extent of the disease. Randomized trials evaluating alternative surgical strategies in coronary surgery are urgently needed in high risk patients.

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…61 Identification of an atherosclerotic aorta is believed to be an important step in reducing the risk of stroke after CABG. 850 Intraoperative assessment of the ascending aorta for detection of plaque by epiaortic ultrasound imaging is superior to direct palpation and TEE. 851 Because the presence of extracranial disease of the internal carotid artery is a risk factor for adverse neurological events after CABG, 860 one might argue for use of carotid noninvasive scanning (duplex ultrasonography or noninvasive carotid screening) in all patients scheduled for CABG.…”

Postoperative Atrial Fibrillation Is Not Associated With an Increase Risk of Stroke or the Type and Number of Grafts: A Single‐Center Retrospective Analysis

“…Interestingly, there was no associated increased risk of stoke in patients with POAF. Postoperative stroke has been associated with the extent of cerebral artery atherosclerosis, 22 extent of atherosclerotic ascending aortic disease, 23 older age, on-pump CABG surgery with hypothermia circulatory arrest, 24 increased cardiopulmonary bypass duration, 25 and POAF. 25,20 However, the historical association between POAF and stroke has been inconsistent.…”

Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients

“…The role of RBC transfusion seems to be independent of other well-recognized causative factors such as atherosclerosis of the ascending aorta and use of cardiopulmonary bypass. Cannulation and clamping of a diseased ascending aorta may be a source of embolism during cardiac surgery [10,14], whereas cardiopulmonary bypass may contribute to major derangements in cerebral circulation secondary to severe hemodilution, inadequate coupling of pump flow and temperature as well as low perfusion pressure [15]. The risk of stroke has been shown to be increased by prolonged cardiopulmonary bypass duration [16].…”