Predictors of Stroke After Cardiac Surgery

Abstract

From January 1, 1988 to September 30, 1993, 44 of 2,455 patients undergoing cardiac surgery for acquired heart disease at our institution sustained an intraoperative or postoperative cerebrovascular accident (CVA). Demographic data, atherosclerosis risk factors, past medical history, cardiac catheterization reports, and intraoperative findings were retrospectively reviewed. The highest rate of CVA was in the sub-group of patients undergoing simultaneous myocardial revascularization and carotid endarterectomy (18.2%). The lowest rate was in a group of patients who underwent aortic valve replacement (0.9%). Severe aortic arch atherosclerosis with the presence of atheromatous material or calcinosis at the cannulation site was identified intraoperatively in 43.2% of patients with neurological complications and in 5% of the group without CVA (x2 = 18.1, p = 0.0001). Of 44 patients with CVA, 13.6% had a history of preoperative completed stroke. CPB time was 90.1 +/- 4.9 min vs. 71.6 +/- 3.7 min (p = 0.004), and aortic cross-clamping time was 54.5 +/- 3.2 min compared to 39.8 +/- 2.7 min (p = 0.001) in groups with and without postoperative stroke, respectively. Hypertension was an independent risk factor of postoperative CVA (x2 = 9.5, p = 0.02), but age was not. Neurological complications correlated with high operative mortality (38.6%) and prolonged postoperative hospital stays (35.1 +/- 5.3). These data describe predictors for the development of post-cardiopulmonary bypass CVA and identify a high-risk subgroup for neurological events. The preoperative recognition of risk factors is an essential step toward the reduction of morbidity and mortality.

The Association of Postcardiac Surgery Acute Kidney Injury with Intraoperative Systolic Blood Pressure Hypotension

“…In addition, hypertension specifically characterized by systolic, diastolic, and pulse pressure subtype has been appreciated as a more complex marker for specific underlying cardiovascular disease and postoperative adverse outcome [3, 4, 8, 25, 27, 28, 38–40]. These data provide evidence that in addition to preoperative BP risk markers, intraoperative systolic blood pressure targets may need to be more carefully considered as well based on presenting information about cardiovascular risk [41–50].…”

Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review

“…Poor hemodynamic control has been reported in the cardiovascular literature to be associated with death, stroke, cognitive and renal dysfunction, perioperative myocardial infarction, and increased mortality [5,12,16,17]. Similarly, the non-cardiac literature also suggests that adequate intraoperative hemodynamic control is integral to outcome during non-cardiac procedures [6,7].…”

How Do HMG-CoA Reductase Inhibitors Prevent Stroke?

“…[74] Severe atherosclerosis of the aortic arch at the time of coronary artery bypass graft (CABG) surgery also has been identified as a major risk factor for neurological complications and associated high operative mortality. [75] In the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) study, [21] the rate of coronary revascularization procedures, either by CABG surgery or percutaneous revascularization, was significantly less in patients treated with pravastatin compared with those treated with placebo.…”