Stroke after CPB: Risk factors

Advances in surgical and perioperative care have reduced stroke rates following coronary artery bypass grafting (CABG). Post-CABG stroke rates are now in <5%. Valvular surgery carries a much higher stroke risk than CABG- likely due to increased cerebral embolic events.

Perioperative strokes after CPB can be separated into ‘early’- present at extubation; and late- occurring post-extubation (1). Risk factors include:

Early (intraoperative) stroke

  • Peripheral & central (aortic) atherosclerotic disease
  • Prior cardiac surgery
  • Left ventricular systolic dysfunction
  • CABG with CPB & circulatory arrest
  • Preoperative renal dysfunction
  • Extended CPB time
  • Old age

Late/postoperative stroke

  • Diabetes
  • Postoperative atrial fibrillation
  • Inotropic support

Both early & late stroke

  • Old age
  • Preoperative atrial fibrillation
  • Previous stroke



  1. McDonagh DL, Berger M, Mathew JP, Graffagnino C, Milano CA, Newman MF. Neurological complications of cardiac surgery. Lancet Neurol. 2014 May; 13(5): 490-502. Review. PubMed PMID: 24703207.