In-hospital stroke in patients after cardiovascular surgery

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Abstract

Introduction. Strokes in patients managed at the department of cardiovascular surgery hold a leading position among all in-hospital strokes in multispeciality hospitals. According to the literature, the prevalence of stroke ranges from 0.2–0.4% for percutaneous cardiac interventions to 16% after heart valve surgeries.

Objective. To reveal the stroke risk factors in patients managed at the department of cardiovascular surgery, including depending on the type of surgical intervention.

Materials and methods. The study group included 58 cases of acute cerebrovascular accidents (ACVA) in patients at the department of cardiovascular surgery, amounting to 30.5% of the total amount of in-hospital strokes recorded over 5 years (2011–2016).

Results. Ischemic stroke was prevalent in the study group (54 patients; 93.1%, р<0.001); four (6.9%) patients had transient ischemic attacks. The largest number of strokes occurred in patients who had undergone heart bypass (23 patients, 41.1%) and heart valve replacement surgeries (25 patients, 44.6%); in 12 (21.4%) patients, ACVA occurred after mitral valve replacement combined with tricuspid annuloplasty. In most cases, stroke developed within the first three days after surgical intervention (36 patients, 64.3%, р<0.05).

Conclusions. Patients who had undergone cardiovascular interventions, especially after heart bypass and heart valve replacement surgeries, require hemodynamic monitoring and thromboelastography during the first 3 days to prevent a stroke. Despite the early detection of in-hospital strokes, systemic thrombolytic therapy was contraindicated for all patients. Mechanical thrombus extraction should be treatment of choice for this category of patients.

About the authors

P. A. Filimonova

Ural State Medical University, Yekaterinburg

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

L. I. Volkova

Ural State Medical University, Yekaterinburg

Email: platonova@neurology.ru
Russian Federation

A. M. Alasheev

Regional Clinical Hospital no. 1, Yekaterinburg

Email: platonova@neurology.ru
Russian Federation

E. A. Grichuk

Regional Clinical Hospital no. 1, Yekaterinburg

Email: platonova@neurology.ru
Russian Federation

References

  1. Hogue C.W., Murphy S.F., Schechtman K.B. et al. Risk Factors for Early or Delayed Stroke After Cardiac Surgery. Circulation. 1999; 100: 642–647. PMID: 10441102.
  2. Gardner T.J., Horneffer P.J., Manolio T.A. et al. Stroke following coronary artery bypass grafting: a ten-year study. Ann Thorac Surg. 1985; 40:574–581. PMID: 3878134.
  3. Tuman K.J., McCarthy R.J., Najafi H. et al. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg. 1992; 104: 1510–1517. PMID: 1453714.
  4. Wareing T.H., Da´vila-Roma´n V.G., Daily B.B. et all. Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg. 1993; 55: 1400–1408. PMID: 8512388.
  5. Ricotta J.J., Faggioli G.L., Castilone A. et al. Risk factors for stroke after cardiac surgery. J Vasc Surg. 1995; 21: 359–364. PMID: 7853607.
  6. Hamon M., Baron J. C., Viader F., MD et al. Periprocedural Stroke and Cardiac Catheterization. Circulation. 2008; 118: 678–683 doi: 10.1161/CIRCULATIONAHA. 108.784504. PMID: 18678784.
  7. Akkerhuis K.M., Deckers J.W., Lincof A.M. et al. Risk of stroke associated with abciximabamong patients undergoing percutaneous coronary intervention. JAMA. 2001; 286: 78–82. PMID: 11434830.
  8. Wong S.C., Minutello R., Hong M.K. Neurological complications following percutaneous coronary interventions: a report from the 2000–2001 New York State Angioplasty Registry. Am J Cardiol. 2005; 96: 1248–1250. DOI: 10.1016/j. amjcard.2005.06.065. PMID: 16253591.

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Copyright (c) 2017 Filimonova P.A., Volkova L.I., Alasheev A.M., Grichuk E.A.

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