Key result
Intraoperative LDL-C decline during cardiac surgery is linked to ~81% lower postoperative stroke risk.
Why the study?
Data on the effect of cardiac surgery and cardiopulmonary bypass on plasma levels of key lipids, and their associations with early postoperative outcomes, were scarce.
Does the perioperative change in plasma lipid levels during cardiac surgery with cardiopulmonary bypass affect the risk of early postoperative clinical outcomes such as stroke, MI, and mortality?
Cohort (n=192)
No
Does the perioperative change in plasma lipid levels during cardiac surgery with cardiopulmonary bypass affect the risk of early postoperative clinical outcomes such as stroke, MI, and mortality?
Cardiac surgery with cardiopulmonary bypass induces a significant acute drop in key plasma lipids, which correlates with a reduced risk of postoperative stroke.
May support perioperative lipid modulation to reduce stroke risk; leaves open causality and requires randomized confirmation before practice change.
Patients undergoing cardiac surgery are at increased cardiovascular risk, which includes altered lipid status. However, data on the effect of cardiac surgery and cardiopulmonary bypass (CPB) on plasma levels of key lipids are scarce. We investigated potential effects of CPB on plasma lipid levels and associations with early postoperative clinical outcomes. This is a prospective bio-bank study of patients undergoing elective cardiac surgery at our center January to December 2019. The follow-up period was 1 year after surgery. Blood sampling was performed before induction of general anesthesia, upon weaning from cardiopulmonary bypass (CPB), and on the first day after surgery. Clinical end points included the incidence of postoperative stroke, myocardial infarction, and death of any cause at 30 days after surgery as well as 1-year all-cause mortality. A total of 192 cardiac surgery patients (75% male, median age 67.0 years (interquartile range 60.0–73.0), median BMI 26.1 kg/m2 (23.7–30.4)) were included. A significant intraoperative decrease in plasma levels compared with preoperative levels (all p < 0.0001) was observed for total cholesterol (TC) (Cliff’s delta d: 0.75 (0.68–0.82; 95% CI)), LDL-Cholesterol (LDL-C) (d: 0.66 (0.57–0.73)) and HDL-Cholesterol (HDL-C) (d: 0.72 (0.64–0.79)). At 24h after surgery, the plasma levels of LDL-C (d: 0.73 (0.650.79)) and TC (d: 0.77 (0.69–0.82)) continued to decrease compared to preoperative levels, while the plasma levels of HDL-C (d: 0.46 (0.36–0.55)) and TG (d: 0.40 (0.29–0.50)) rebounded, but all remained below the preoperative levels (p < 0.001). Mortality at 30 days was 1.0% (N = 2/192), and 1-year mortality was 3.8% (N = 7/186). Postoperative myocardial infarction occurred in 3.1% of patients (N = 6/192) and postoperative stroke in 5.8% (N = 11/190). Adjusting for age, sex, BMI, and statin therapy, we noted a protective effect of postoperative occurrence of stroke for pre-to-post-operative changes in TC (adjusted odds ratio (OR) 0.29 (0.07–0.90), p = 0.047), in LDL-C (aOR 0.19 (0.03–0.88), p = 0.045), and in HDL-C (aOR 0.01 (0.00–0.78), p = 0.039). No associations were observed between lipid levels and 1-year mortality. In conclusion, cardiac surgery induces a significant sudden drop in levels of key plasma lipids. This effect was pronounced during the operation, and levels remained significantly lowered at 24 h after surgery. The intraoperative drops in LDL-C, TC, and HDL-C were associated with a protective effect against occurrence of postoperative stroke in adjusted models. We demonstrate that the changes in key plasma lipid levels during surgery are strongly correlated, which makes attributing the impact of each lipid to the clinical end points, such as postoperative stroke, a challenging task. Large-scale analyses should investigate additional clinical outcome measures.
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Mihalj et al. (2021) conducted a cohort in Elective cardiac surgery (n=192). Pre-to-post-operative changes in plasma lipid levels during cardiac surgery vs. Preoperative lipid levels was evaluated on Postoperative stroke associated with pre-to-post-operative changes in LDL-C (aOR 0.19, 95% CI 0.03-0.88, p=0.045). Intraoperative decreases in key plasma lipids, including LDL-C, during cardiac surgery were significantly associated with a reduced risk of postoperative stroke (aOR 0.19).
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