Preoperative stroke before cardiac surgery does not increase risk of postoperative stroke

Abstract

The optimal time when surgery can be safely performed after stroke is unknown. The purpose of this study was to investigate how cardiac surgery timing after stroke impacts postoperative outcomes between 2011–2017 were reviewed. Variables were extracted from the institutional Society of Thoracic Surgeons database, statewide patient registry, and medical records. Subjects were classified based upon presence of endocarditis and further grouped by timing of preoperative stroke relative to cardiac surgery: Recent (stroke within two weeks before surgery), Intermediate (between two and six weeks before), and Remote (greater than six weeks before). Postoperative outcomes were compared amongst groups. 157 patients were included: 54 in endocarditis and 103 in non-endocarditis, with 47 in Recent, 26 in Intermediate, and 84 in Remote. 30-day mortality and postoperative stroke rate were similar across the three subgroups for both endocarditis and non-endocarditis. Of patients with postoperative stroke, mortality was 30% (95% CI 4.6–66). Timing of cardiac surgery after stroke occurrence does not seem to affect postoperative stroke or mortality. If postoperative stroke does occur, subsequent stroke-related mortality is high.

Screening neuroimaging in neurologically asymptomatic patients with infective endocarditis

“…However, several studies have shown that patients with preoperative stroke have a low risk for hemorrhagic transformation during surgery. 18,19 Our findings are consistent with previous work by Thuny et al…”

“…In clinical practice, preoperative neuroimaging may be useful to risk stratify patients prior to cardiac surgery given that anticoagulation is often used intraoperatively. However, several studies have shown that patients with preoperative stroke have a low risk for hemorrhagic transformation during surgery 18,19 …”

ESC guidelines 2023 on the management of endocarditis

“…When haemodynamic disturbances are present, surgery should be pursued without delay (see Figure 11 and Recommendation Table 17). 451,468,473,567,568,[570][571][572][573][574][575][576][577][578] A more common situation occurs when surgery is considered for the prevention of recurrent embolism after stroke, due to the presence of large vegetations (>10 mm). In patients that have suffered a transient ischaemic attack, the risk of surgery is usually low and surgery should be performed without delay.…”

Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

“…The critical task at hand is the optimization of the patient before surgery. This may require a postponement of the surgery, but there is a relative paucity of data to guide optimal timing [77,78]. Some advanced computational techniques (artificial intelligence) may help determine the optimal procedure timing, allowing more time for patient optimization [74].…”