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
Sources
PubMed
- 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.
