Stroke After Coronary Bypass Surgery Is Mainly Related to Diffuse Atherosclerotic Disease

Authors

  • Sahin Senay
  • Fevzi Toraman
  • Yasemin Akgün
  • Ebuzer Aydin
  • Hasan Karabulut
  • Cem Alhan
  • Tayyar Sarioglu

DOI:

https://doi.org/10.1532/HSF98.20111031

Abstract

Objective: This study aims to investigate the risk factors for postoperative stroke and analysis of outcome after coronary bypass surgery with cardiopulmonary bypass.

Methods: Between 1999 and 2008, 3248 consecutive patients who underwent isolated coronary surgery with cardiopulmonary bypass were prospectively enrolled in the study. Demographic and perioperative data were analyzed. Postoperative stroke was defined as severe adverse neurological events including permanent deficits or cerebral lesions with radiological demonstration of cerebral infarction within the first postoperative month.

Results: In total, 32 patients (0.9%) were determined with stroke. Univariate risk factors for postoperative stroke were determined as preoperative unstable angina (P = .006), Canadian Class of Angina (CCA) ? 3 (P = .001), preoperative creatinin level >1.2 mg/dL (P = .001), left main coronary artery disease (P = .04), chronic obstructive lung disease (P = .04), peripheral arterial disease (P < .001), New York Heart Association (NYHA) Class ? 3 (P = .004), preoperative renal insufficiency (P = .001), age > 65 years (P = .04), preoperative hypothyroidism (P = .02), postoperative low cardiac output state (P < .001), severe coronary artery disease requiring distal anastomosis ? 4 (P = .05), non-elective operation (P = .02), and body mass index ? 25 (P = .02). Multivariate analysis revealed peripheral arterial disease (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.9-14.0; P = .001), severe coronary artery disease (OR, 3.1; 95% CI, 1.1-8.5; P = .02), and postoperative low cardiac output state (OR, 5.1; 95% CI, 1.4-18.2; P = .01) as the independent risk factors.

Conclusions: Stroke after coronary bypass surgery with cardiopulmonary bypass is mainly related to diffuse atherosclerotic disease.

References

Anyanwu AC, Filsoufi F, Salzberg SP, Bronster DJ, Adams DH. 2007. Epidemiology of stroke after cardiac surgery in the current era. J Thorac Cardiovasc Surg 134:1121-7.nAranki SF, Sullivan TE, Cohn LH. 1995. The effect of the single aortic cross-clamp technique on cardiac and cerebral complications during coronary bypass surgery. J Card Surg 10:498-502.nAscione R, Reeves BC, Chamberlain MH, Ghosh AK, Lim KH, Angelini GD. 2002. Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study. Ann Thorac Surg 74:474-80.nBanerjee A, Fowkes FG, Rothwell PM. 2010. Associations between peripheral artery disease and ischemic stroke: implications for primary and secondary prevention. Stroke 41:2102-7.nBreuer AC, Furlan AJ, Hanson MR, et al. 1983. Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients. Stroke 14:682-7.nBrizzio ME, Zapolanski A, Shaw RE, Sperling JS, Mindich BP. 2010. Stroke-related mortality in coronary surgery is reduced by the off-pump approach. Ann Thorac Surg 89:190-23.nBronster DJ. 2006. Neurologic complications of cardiac surgery: current concepts and recent advances. Curr Cardiol Rep 8:9-16.nBucerius J, Gummert JF, Borger MA, et al. 2003. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 75:472-8.nCharlesworth DC, Likosky DS, Marrin CA, et al. 2003. Development and validation of a prediction model for strokes after coronary artery bypass grafting. Ann Thorac Surg 76:436-43.nChu D, Bakaeen FG, Dao TK, Lemaire SA, Coselli JS, Huh J. 2009. On-pump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients. Ann Thorac Surg 87:1820-6.nDacey LJ, Likosky DS, Leavitt BJ, et al. 2005. Perioperative stroke and long-term survival after coronary bypass graft surgery. Ann Thorac Surg 79:532-6nD'Ancona G, Saez de Ibarra JI, Baillot R, et al. 2003. Determinants of stroke after coronary artery bypass grafting. Eur J Cardiothorac Surg 24:552-6.nDoobay AV, Anand SS. 2005. Sensitivity and specificity of the anklebrachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 25:1463-9.nGold JP, Charlson ME, Williams-Russo P, et al. 1995. Improvement of outcomes after coronary artery bypass: a randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 110:1302-11.nMcKhann GM, Grega MA, Borowicz LM Jr, Baumgartner WA, Selnes OA. 2006. Stroke and encephalopathy after cardiac surgery: an update. Stroke 37:562-71.nMorice MC, Serruys PW, Kappetein AP, et al. 2010. Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 121:2645-53.nPatel NC, Deodhar AP, Grayson AD, et al. 2002. Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass. Ann Thorac Surg 74:400-5.nPuskas JD, Winston AD, Wright CE, et al. 2000. Stroke after coronary artery operation: incidence, correlates, outcome, and cost. Ann Thorac Surg 69:1053-6.nStamou SC, Hill PC, Dangas G, et al. 2001. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke 32:1508-13.nZingone B, Rauber E, Gatti G, et al. 2006. The impact of epiaortic ultrasonographic scanning on the risk of perioperative stroke. Eur J Cardiothorac Surg 29:720-8.n

Published

2011-12-13

How to Cite

Senay, S., Toraman, F., Akgün, Y., Aydin, E., Karabulut, H., Alhan, C., & Sarioglu, T. (2011). Stroke After Coronary Bypass Surgery Is Mainly Related to Diffuse Atherosclerotic Disease. The Heart Surgery Forum, 14(6), E366-E372. https://doi.org/10.1532/HSF98.20111031

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