Strokes after cardiac surgery: mostly right hemispheric ischemic with mild residual damage

Korn‐Lubetzki, Isabelle; Oren, Avraham; Asher, Esther; Dano, Marina; Bitran, Daniel; Fink, Daniel; Steiner-Birmanns, Bettina

doi:10.1007/s00415-007-0633-5

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…Mortality rates reported were anywhere between 0.2 for elective mitral valve repair [19] to 11.6% for valve replacement [9] versus an observed mortality rate of 1.4% in the current analysis including valve replacement, combined and reoperative cases. The reported major stroke rates in elective mitral valve repair were between 0.6% [19] and 4.4% [11] versus an observed major stroke rate of 0.8% in our study population including valve replacement, combined and reoperative procedures.…”

Section: Literature Comparisoncontrasting

confidence: 57%

“…We compared the results to the currently available literature on isolated mitral valve surgery either minimally invasively or through full sternotomy [1,2,4,[8][9][10][11][12][13][14][15][16][17][18][19]. Mortality rates reported were anywhere between 0.2 for elective mitral valve repair [19] to 11.6% for valve replacement [9] versus an observed mortality rate of 1.4% in the current analysis including valve replacement, combined and reoperative cases.…”

Section: Literature Comparisonmentioning

confidence: 99%

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Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience

Casselman¹,

Aramendi²,

Bentala³

et al. 2015

The Annals of Thoracic Surgery

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Background. Some controversy exists regarding the safety of endoaortic balloon clamping in minimal access isolated mitral valve surgery (MIMVS). The aim of this European multicenter study was to analyze the results in 10 experienced centers and compare the outcomes with published data.Methods. The most recent 50 consecutive MIMVS cases from10 European surgeons who had performed at least 100 procedures were prospectively collected and retrospectively analyzed. All procedures were performed through right minithoracotomy with femoral cannulation and endoaortic balloon occlusion. In-hospital and 30-day outcomes were studied. Mortality and stroke rates were compared with published median sternotomy and MIMVS outcomes.Results. Mean age was 63.2 ± 12.5 years, 289 (57.8%) were male, mean logistic European system for cardiac operative risk evaluation was 6.1 ± 6.2, and 53 (10.6%) procedures had cardiac reoperations. Concomitant procedures were performed in 126 (25.9%) cases. Three patients (0.6%) required conversion to full sternotomy. Ten patients (2.0%) necessitated endoaortic balloon clamping conversion (8 to external clamping), and

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Section: Literature Comparisoncontrasting

confidence: 57%

Section: Literature Comparisonmentioning

confidence: 99%

Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience

Casselman¹,

Aramendi²,

Bentala³

et al. 2015

The Annals of Thoracic Surgery

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“…[5][6][7][8] Considering any thrombus inside the LVAD pump as a part of cardiac embolic material in addition to actual intracardiac thrombi, right-to-left propensity of stroke after LVAD can be easily explained by anatomic alignment of the arteries arising from aortic arch. Moreover, surgical manipulation of LVAD outflow cannula-to-ascending aorta anastomosis may also direct embolic material toward the brachiocephalic trunk.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 Cerebral embolic events after cardiac surgery are frequently distributed more often in the right cerebral hemisphere. [5][6][7] Kim et al 8 reported recently that right hemispheric infarcts are associated with cardiogenic embolism, whereas left hemispheric infracts are more associated with aortogenic embolism. In the present study, we investigated the distribution of stroke in patients undergoing LVAD implantation and whether clinical characteristics differed in LVAD patients experiencing right versus left hemispheric stroke.…”

mentioning

confidence: 99%

Asymmetric Pattern of Cerebrovascular Lesions in Patients After Left Ventricular Assist Device Implantation

Kato¹,

Ota²,

Schulze³

et al. 2012

Stroke

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Background and Purpose-Stroke is a major adverse event after left ventricular assist device (LVAD) surgery. The purpose of this study was to describe differences in hemispheric distribution of stroke in LVAD patients. Methods-We reviewed 317 consecutive patients who underwent LVAD surgery between November 2000 and July 2011.Stroke during LVAD support was analyzed. Results-In total, 46 strokes occurred at 76.0Ϯ96.8 days postoperatively. Among the 46 strokes, 27 events (58.7%) occurred in right hemisphere, 13 events (28.2%) in the left hemisphere, 3 events (8.7%) occurred bilaterally, and 2 events (4.3%) were vertebrobasilar lesions. The right hemispheric stroke was significantly more common in patients with postoperative infection compared with left hemispheric events. Conclusions-Stroke after LVAD implantation has a right hemispheric predominance. This finding suggests LVADrelated thrombus in the setting of infection and/or the anatomic configuration of LVAD outflow cannula-ascending aorta anastomosis to be highly associated with stroke after LVAD surgery. (Stroke. 2012;43:872-874.)

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“…Diagnosis of acute CVA or other neurological complications was done during the hospitalization and was included in the database after discharge. For our study, charts of all patients diagnosed during hospitalization with neurological complications were reviewed by an experienced neurological team and the diagnosis was reassessed [8]. …”

Section: Methodsmentioning

confidence: 99%

No Symptomatic Intracerebral Hemorrhage after Cardiac Surgery: A 14-Year Retrospective Study

Korn‐Lubetzki

Oren²,

Tauber³

et al. 2010

Eur Neurol

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Background: In the presence of new neurological findings occurring after cardiac surgery, the clinical question is whether to exclude symptomatic intracerebral hemorrhage (ICH), particularly in the context of routine postoperative anticoagulation treatment. Methods: This is a retrospective 14-year study including 5,275 patients who underwent cardiovascular surgery. The control cohort included all patients with acute cerebrovascular accidents hospitalized in 2 general hospitals in Jerusalem during a 2-month period in 2007 (part of a national survey). Results: After cardiac surgery, 78 patients developed ischemic strokes, mostly of large-vessel etiology. These ischemic strokes occurred more often in patients who underwent combined operations (22/647 = 3.4% vs. 45/3,489 = 1.3%; p = 0.0004). ICH was found in 6% of all acute cerebrovascular accidents in the general survey, but was absent after cardiac surgery (5 vs. 0; p = 0.02). Conclusions:Despite hypertension as a main risk factor and the administration of postoperative anticoagulation, we found that symptomatic ICH did not occur after cardiac surgery.

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Strokes after cardiac surgery: mostly right hemispheric ischemic with mild residual damage

Abstract: Strokes after cardiac surgery are mostly right hemispheric and exclusively ischemic. Outcome is relatively fair. We suggest an embolic injury to the right hemisphere, procedure related, as a possible mechanism.

Cited by 17 publications

References 22 publications

Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience

Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience

Asymmetric Pattern of Cerebrovascular Lesions in Patients After Left Ventricular Assist Device Implantation

No Symptomatic Intracerebral Hemorrhage after Cardiac Surgery: A 14-Year Retrospective Study

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