August 1, 2004The Heart Surgery ForumOpen Access

Intraoperative and Postoperative Variables Associated with Strokes following Cardiac Surgery

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Why the study?

Are intraoperative and postoperative variables, such as atrial fibrillation and prolonged cardiopulmonary bypass, associated with specific stroke mechanisms following isolated CABG surgery?

Population

13,897 patients who underwent isolated coronary artery bypass grafting surgery in northern New England…

Comparison

Intraoperative and postoperative risk factors… vs Patients without strokes or patients without the…

Design

Cohort

Follow-up

In-hospital (prior to discharge)

Authors

DLDonald S. LikoskyCardiac Surgery LCLouis R. CaplanUniversity of Arkansas at Little Rock RWRonald M. WeintraubKaiser Permanente Oakland Medical Center

Discussion

Member takes

Implication

May warrant closer post-CABG monitoring for AF and prolonged bypass; hypothesis-generating for mechanism-specific prevention trials.

Structured PICO

Are intraoperative and postoperative variables, such as atrial fibrillation and prolonged cardiopulmonary bypass, associated with specific stroke mechanisms following isolated CABG surgery?

Population

13,897 patients who underwent isolated coronary artery bypass grafting (CABG) surgery in northern New England between April 1992 and June 2000. Excluded patients who underwent off-pump CABG and CABG associated with heart valve surgery, resection of ventricular aneurysm, or any other surgical procedure.

Intervention

Intraoperative and postoperative risk factors, specifically cardiopulmonary bypass duration, cross-clamp duration, intra-aortic balloon pump use, low cardiac output syndrome, and postoperative atrial fibrillation.

Comparator

Patients without strokes (for multinomial logistic regression) or patients without the specific risk factor (e.g., cardiopulmonary bypass <60 minutes, no postoperative atrial fibrillation).

Outcome

Occurrence and mechanism of stroke (classified as embolic, hypoperfusion, or mixed) occurring during or following the CABG procedure that appeared and was established prior to discharge.hard clinical

Postoperative atrial fibrillation and prolonged cardiopulmonary bypass are significant independent predictors of embolic and hypoperfusion strokes following isolated CABG surgery.

Limitations

Insufficient observations for some stroke mechanisms requiring collapsing into 3 broad categories
Mixed-stroke category represents combinations of many stroke mechanisms
Lacks information regarding the timing of stroke mechanisms with respect to the new onset of postoperative atrial fibrillation and low cardiac output syndrome
Lacks reliable information concerning the management or the extent of aortic disease
Lacks consistent data from echocardiograms regarding cardiac function and potential cardiac sources of emboli

Cite This Study

Likosky et al. (2004) studied this question.

synapsesocial.com/papers/6a729b30febe604dd70aaf94 https://doi.org/10.1532/hsf98.20041035

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Intraoperative and Postoperative Variables Associated with Strokes following Cardiac Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Intraoperative and Postoperative Variables Associated with Strokes following Cardiac Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider